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THE CENTURY BOOK 
FOR MOTHERS 



THE CENTURY BOOK 
FOR MOTHERS 



A PRACTICAL GUIDE 
IN THE REARING OF 
HEALTHY CHILDREN 

BY 
LEROY MILTON YALE, M. D. 

FORMERLY LECTURER ON THE DISEASES OF CHILDREN 

AT BELLEVUE HOSPITAL MEDICAL 

COLLEGE, NEW YORK 

AND 

GUSTAV POLLAK 

EDITOR OF "BABYHOOD" 




THE CENTURY CO. 
NEW YORK . . . 1901 



Xv 



^ 



V. 



A 



THE LIBRARY OF 
CONGRESS, 

Two Coptta Received 

SEP. 25 1901 

Copyright entry 
CUASS CO XXc. N«. 

I COPY a 






Copyright, 1901, 
By The Century Co. 

Published, October, 1901. 



The DeVinne Press. 



PREFACE 

IN preparing "The Century Book for Mothers" the au- 
thors have endeavored to keep in mind two queries : What 
ought an intelligent mother to know, and, beyond that, what 
would she Avish to know, regarding the care of her child ? 

As regards the first, the writers have believed that she 
should understand matters of hygiene rather than the treat- 
ment of diseases ; that she should know the things which go 
to the establishing and preserving of healthful conditions; 
and that she should be aided in the recognition and avoid- 
ance of disease, rather than in its cure. In other words, 
their object has been to help the intelligent mother to be- 
come the alert and judicious guardian of the nursery, rather 
than to tempt her to play the physician and to dabble in 
dosing. In the first part of the book special emphasis has 
been laid on the caring for children, including the feeding, 
clothing, and housing. The subject of diseases, systemati- 
cally even if somewhat briefly discussed in Part I, receives 
additional treatment in Part II. 

As to the inquiry— What kind of information, beyond 
what she ought to possess, is the mother likely to seek? — 
the writers could think of no better way of giving such in- 
formation than to follow the questions actually put by 
mothers to them as editors, for many years, of a magazine 
devoted to the care of children. The second part of the 
book is therefore almost entirely made up of a large number 



viii PREFACE 

of questions concerning the many perplexities of daily nur- 
sery life, together with the answers furnished. The authors 
believe that in so doing they have more nearly approached 
the mother's point of view, and better met her needs, than 
by any systematic treatment of nursery matters they could 
have devised. Their aim has been to cover in this way the 
common ailments and troubles of early childhood, and they 
hope that, all in all, the volume may be found an instruc- 
tive and safe guide for mothers in the care of children both 
in health and in illness. 



CONTENTS 

PART I 
THE GENERAL CARE OF CHILDREN 

PAGE 

I The Preparation for Motherhood 3 

Diet — Dress — Exercise and Clothing — Discomforts — Care of 
the Breasts — The Monthly Nurse — Time of Confinement — 
The Outfit of the Lying-in Chamber — The Baby Basket 

— Preparations for the Bath — Precautions for the Mo- 
ther — The Value of a Cheerful Frame of Mind. 

II The Nursery 18 

Light and Air — Ventilation and Heating — The Proper Tem- 
perature — Lights — Nursery Furnishiugs. 

III The New Baby 25 

Baby's First Bath — Special Precautions — The Navel-String. 

IV Nursery Routine so 

Hours of Sleep — Disturbed Sleep — Suckling — Crying — Un- 
successful Suckling — The Mother's Diet — Bathing. 

V Baby's Airing and Exercise 40 

The Baby-Carriage — Exercise for Older Children. 

VI Dress and Clothing 44 

The Principal Eequirements in Dress— The Napkins — Socks 

— Old-Fashioned Clothing— The ''Gertrude" Suit — Night 
Dress — Shoes — Fashion in Dress — Stocking Supporters and 
Drawers — Garments for Older Children. 

VII Growth and Development 59 

Gain in Weight— Gain in Height — Muscular Development— 
The Special Senses— Speech — The Teeth— Teething — Sat- 
isfactory Growth — Outgrowing Defects — Phimosis — Condi- 
tions of Proper Development, 
ix 



X CONTENTS 

PAGE 

vm Food and Feeding 77 

Breast Milk — Artificial Feeding — Cow's Milk — Purity of the 
Milk Supply— The Constituents of Milk — Modified Milk 
— Varying Proportions in Feeding — Bottles, Nipples, and 
Measures — The Separation of Cream — Various Mixtures — 
Feeding Conveniences — Sterilization — Gruels — Broths and 
Meat Juice — The Second Year — The Feeding of Older 
Children — Digestibility of Food— The Chewing Teeth — 
Meat and Eggs — Zwieback and Crackers — Gruels and Por- 
ridges —Fruits — Potatoes — The Five Meals — Feeding After 
the Second Year — General Rules for Diet — The Third Year 
and Thereafter— ^'Animal Foods"— The Value of Eggs — 
Various Meats — Fish as Food — Soups — Vegetables — Bread 
and Cereals — Macaroni — Desserts — Fruit — Water and 
Other Drinks — Objections to Sweets. 

IX Disorders Associated with Improper Feeding 124 

Symptoms of Rickets — Changes Due to Rickets — Causes 
and Cure of Rickets — Infantile Scurvy — Causes and Cure of 
Scurvy — Habitual Constipation — Hygienic Treatment of 
Constipation — Massage — Siippositories — Enemata and Lax- 
ative Medicines — Varieties of Diarrhoea — Rules for all Cases 
of Diarrhoea — Stomach Indigestion and Colic. 

X The Evidences of Illness 136 

General Behavior — The Head, Face, and Eyes — Signs About 
the Mouth — Throat Troubles — The Voice — The Ears- 
Breathing — Various Coughs — Vomiting — The Urine and 
Bowel Discharges — Fevers — Symptoms of Contagious Dis- 
eases — The Invasion Period — Characteristic Eruptions — 
Periods of Isolation. 

XI Domestic Treatment of Illness 149 

Precautionary Measures — The Warm Bath — Medicated 
Baths — How to Give Baths — Sponge-Baths — Vapor-Baths— 
Cold Compresses — Hot Applications — Poultices — How to 
Apply Poultices — Jackets for the Chest — Cathartics — Calo- 
mel — The Giving of an Enema. 

XII Hints Regarding the Administration of Medicines . .162 

Liquid Medicines — Ways of Giving Medicines — How to Pre- 
pare a Dose — Iron Preparations — Castor-Oil — Medicines in 
Solid Form — Swallowing Made Easy — Rules for the Sick- 
Room, 



CONTENTS xi 

PAGE 

XIII Nursery Emergencies 169 

Domestic Surgery — Ragged Wounds — The Cleansing of 
Punctured Wounds — Bruises and Bumps — Sprains — Burns 
and Scalds — Cautions as to Fire — Frost-Bite and Chilblains 
— Removal of Foreign Bodies — Nosebleed — Resuscitation 
in Drowning Accidents — Convulsions — Accidents Due to 
Poison. 

XIV The Household Pharmacy 182 

Conveniences — For Surgical Needs — Disinfectants — Medi- 
cines — Emetics — Carminatives — Remedies for Fever — . 
Bromides — Opium Preparations — Various Antidotes. 



PART II 

QUESTIONS AND ANSWERS 
Minor Ailments and Troubles 193 

The Causes and Treatment of Colic — Colic and Teething — 
Colic Accompanying Nursing — ''Three-Months' Colic" — 
Cure for Cold Hands — Cold Feet as a Consequence of Short 
Clothes — Perspiring Feet — Enlargement of Glands — Prob- 
able Cause of Mouth-Breathing — Enlarged Uvula — Patches 
on the Tongue — Coated Tongue — The Prevalence of " Sore 
Mouth " — The Causes of Sore Mouth — Swollen Tonsils — 
Roughness of the Voice — Bed- Wetting — Bed-Wetting in a 
Nervous Child — The Cause and Cure of Hiccough — Exces- 
sive Nosebleeding — Gritting the Teeth as a Symptom of 
Worms — The Signs of Worms — The Cause of Pin- Worms — 
Treatment for Pin-Worms — Persistent Itching of the Nose — 
What to do for an Attack of False Croup — The Treatment of 
Bumps — Drowsiness Following a Bump on the Head — , 
Fainting — Cracked Lips and Chapped Skin. 

Defects and Blemishes 219 

Freckles — A Mark on Baby's Face — The Removal of a Birth- 
Mark — Waits — The Beginning and Treatment of Stammer- 
ing — Lisping — Want of Symmetry in the Formation of the 
Head — Umbilical Growth — Round Shoulders — Fear of Bow- 
Legs — Remedies for Bow-Legs — A Confirmed Habit of 
Stumbling — A Tongue-Tied Baby — Cleft Palate and Harelip 
— " Whopper- Jaw " — Deaf -Mutism. 



xii CONTENTS 

PAGE 

III Colds and Catarrh 233 

Fresh Air and Colds — Comprehensive Questions Concerning 
Coughs and Colds — Treatment of a " Hard Cold" — Causes 
and Treatment of Catarrh — The Communicability of Catarrh 

— Care of a Sensitive Throat — Taking Cold Easily — Cold in 
the Head ; Application of Vaseline — '■ Starving a Cold." 

IV Whooping-Cough 243 

The First Symptoms of Whooping-Cough — Supposed Igno- 
rance of Physicians Concerning Whooping-Cough — Contagion 
of Whooping-Cough — Severity of Whooping-Cough in Rela- 
tion to Age. 

V Difficulties of Walking and Disorders of the Limbs 247 

The Possible Dangers from Early Walking — Possibly Over- 
burdened Limbs — Turning-in of the Toes — Disinclination to 
Put the Foot Down — Weak Limbs — The Significance of a 
Limp — Pott's Disease — Knock-Knee — Weak Ankles. 

VI Constipation 253 

Constipation in both Mother and Child ; Laxative Diet ; The 
Action of Senna — Magnesia as a Laxative — Constipation in 
a '^ Bottle Baby" — Castile-Soap Suppositories; Candy Sup- 
positories — Objections to Suppositories ; The Effect of Mas- 
sage ; The Value of Regular Habits — The Effect of an Enema. 

VII Various Digestive Disturbances 258 

A Probable Case of '' Dyspepsia " — Habitually Coated Tongue 

— Excessive Perspiration of the Head and Other Signs of 
Rickets — The Uses of Bicarbonate and Phosphate of Soda 
for Weak Digestion — ''Liver Troubles" — Domestic Treat- 
ment of Summer Complaint — Apparent Overfeeding — Indi- 
gestion; Dilution of Milk Called for — Paregoric for Green 
Movements — The Causes of Dirt-Eating. 

VIII Eruptions 266 

The Characteristics of Mild and of Serious Eruptions — '' Driv- 
ing In" Eczema — Heat-Rash — Red-Gum — Psoriasis — Se- 
borrhoea — Ringworm — Herpes and its Cure — * 'Black- 
Heads " — The Cause and Cure of Hives. 

IX Common Diseases 277 

Precautions in a Case of Diphtheria — General Experiences 
with Antitoxin — Antitoxin as a Preventive and Cure — Ques- 
tions as to Diplitheria and Membranous Croup ; Popular Mis- 
conception of Medical Terms — Croup — Characteristics of 



CONTENTS xiii 

PAGE 

Malarial Disorders — Remedies for Malarial Fever — The 
Causes and Treatment of Typhoid Fever — Symptoms of 
Typhoid Fever — The Usual Symptoms and Treatment of 
Scarlet Fever — Characteristics of Measles — German Measles 
or Rotheln — The Causes and Characteristics of Rheumatism 

— The Contagiousness of Mumps — The Value of Gargling in 
Sore Throat ; Different Kinds of Sore Throat — St. Vitus's 
Dance — Signs of Heart Trouble — Alcoholic Stimulants in 
Fevers — The Value of Cod-Liver Oil in Cases of Scrofula — 
A Case of Tape- Worm in a Four-year-old Child— The Causes 
of Meningitis — Jaundice ; Biliousness — Hydrocephalus, or 
Water on the Brain — The Characteristics of Hernia — The 
Causes of Rupture — Treatment of Hernia — Treatment of a 
Protruding Navel — Falling of the Bowel. 

X Harmful Habits 302 

Thumb-Sucking — Objections to "Baby's Comforter " — Hold- 
ing the Breath — Nail-Biting and Its Cure — The Che wing- 
Gum Habit in Children — Lip-Sucking. 

XI Phases of Development 307 

The Infant's Normal Weight — Measurements and Weights of 
Boys and Girls at Various Ages — When Children First Begin 
to See — Development of the Saliva and Tear-Glands — The 
Development of Speech — Imperfect Nutrition and its Causes 

— Drooping Shoulders — Left-Handedness. 

XII Weaning 3i3 

Systematic Weaning — Dropping the Night Meal — Nursing 
During Pregnancy. 

XIII Sleeping 3i6 

The Hammock as a Sleep-Inducer — Putting a Baby to Sleep 
with the Rubber Nipple ; " Magic" Effects of Sugar-Rags — 
Experimenting with Anodynes — A Night-Light in the Nur- 
sery — The Value of the Pillow in Sleeping — The Most Com- 
fortable Pillow — The Fir-Pillow — Objections to Having 
Children Sleep With Adults — Position for Sleep — Sleeping 
on the Stomach — The Causes of Night Terror — Worms as 
Possible Causes of Talking in Sleep. 

XIV Bathing 324 

A Bath at Night — The Effects of Cold and Wai-m Baths — 
Soap — Diminishing the Frequency of Baths — The Outing 
After a Bath. 

XV Teething 328 

Is Normal Teething Painless? — Late Teething — Drooling. 



xiv CONTENTS 

PAGE 

XVI The Teeth 333 

Strengthening the Teeth — Effect of Early Feeding Upon the 
Teeth ; the Use of the Tooth-Brush —Early Decay of Teeth — 
Discoloration of the Teeth — Peculiarity of Teeth — Removing 
Redundant or ''Extra" Teeth— The Filling of the First 
Teeth — Unusual Absence of Upper Incisors. 

XVII The Eyes 339 

Squint— Test for Cross-Eyes — Needless Anxiety about Bril- 
liant Eyes — Eye-Pupils of Different Sizes — Sties — Clipping 
the Eyelashes — A " Weeping" Eye — Eye-Strain as a Cause 
of Headache — Pink-Eye — Granular Eyelids — Astigmatism. 

XVIII The Ears 346 

Earache — Partial Deafness — Prominent Ears — Tampering 
with Large Ears — Hardening of Ear- Wax — Cause and Pre- 
vention of Ear Trouble — Significance of a Running Ear. 

XIX The Hair and Scalp 351 

strengthening Thin Hair — Washing the Scalp — The Use of 
Soap on the Head — Tampering with the Color of the Hair — 
Milk-Crust — The Belief that Long Hair is Weakening. 

XX The Feet 355 

Incipient Corns — Distorted Feet — Ingrowing Nails. 

XXI Hygiene and Sanitation 359 

The Objections to Vaccination ; Supposed Failure of Vaccina- 
tion to Protect ; the Proper Age for Vaccination — The Dis- 
advantage of Postponing Vaccination — The Desirability of 
Keeping Water on the Stove — Plants in the Bedroom — 
Proper and Improper Filters — Sulphur for Disinfection— Disin- 
fectants — Ground Air from Excavations ; Quinine as a Preven- 
tive of Fever and Ague — Temperature of the Nursery and the 
Bedroom — The Gas-Stove in the Nursery — How Longdo Diph- 
theria Germs Linger f — Danger of Typhoid Fever to Babies 
from Impure Drinking- Water — Susceptibility to Second At- 
tacks of Disease — Physical Exercise for Girls — Disinfecting 
Paper Money from a Sick-Room — Baby Powder — The Value 
of Water in Rheumatism — The Treatment of Nervous Chil- 
dren — The Hardening Theory — Hardening in Practice — 
Rational and Injurious School-Work; the School Lunch — 
Over-Study as a Cause of Chorea. 

XXII Questions of Dress 376 

The Knitted Band ; Getting Rid of the Piuning-Blanket — 
Seasonable Dress for a Five-Months-Old; Silk or Flannel? — 
Night Coverings — The Nightcap ; Stockings at Night — Sum- 



CONTENTS XV 

PAGE 

mer Dress — Summer Night-Clothing — Clothing for Winter — 
The Value of Long Stockings — Stiff Soles for Babies — Gar- 
ters and Stocking-Supporters — Proper Stockings and Shoes 
for a Depressed Toe — The Advisability of Going Barefoot. 

XXIII Care of the Mother 385 

Nervousness in the Mother as a Cause of Baby's Colic — A 
Sensitive Breast — Sore Nipples — The Diet of a Nursing 
Mother — The Best Method of Drying up the Mother's Milk — 
" Nursing Sore Mouth " — Excess of Abdominal Fat — Falling 
Out of the Hair after Confinement. 

XXIV special Requirements and Perplexing Points in the 

Nursery Routine 394 

Crying and Sedatives — Hard Crying as a Cause of Rupture — 
Rocking the Baby — Age for Sitting up in the Chair — Baby in 
the Corner — Playing on the Floor — The Effects of " Jostling 
About " — Rapid Carriage-Driving for Very Young Children — 
Methods of Lifting the Baby — Objections to a Veil — Teach- 
ing the Use of the Nursery Chair — The Care of Finger-Nails — 
Supposed Advantages of Being the " Middle Child" — Unjus- 
tified Fear of Consumption — The Definition of Nervousness 
— Washing the Infant's Mouth — The Giving of an Enema — 
The Mustard-Plaster — Kissing by Force. 

XXV Feeding Problems 408 

The Selection of a Wet-Nurse — Can the Nurse's or Mother's 
Milk be Poisonous ? — The Flow of Milk the First Days after 
Delivery — Goat's Milk and Ass's Milk — Testing the Quality 
of Breast Milk — Objections to Giving Breast Milk by Spoon — 
Bottle versus Spoon — *' Sucking Wind" — Combined Nursing 
and Bottle-Feeding at One Meal — The Signs of Insufficient 
Breast Milk — Nursing Another Baby in Addition to One's 
Own — The Supply of Breast Milk as Compared with the 
Allowance of Bottle-Fed Babies — Evils of Early Mixed Feed- 
ing ; Effect of the Mother's Diet Upon the Child's Teething — 
Feeding at Night after Weaning — The Tests of Rich Milk — 
Scum on Boiled Milk — A Warning against Sour Milk — Dan- 
gers from Impure Milk ; When Sterilization is Necessary — 
Keeping Sterilized Milk in Summer — Does Sterilized Milk 
Constipate ? — Injurious Quality of Lime-Water — Food versus 
Sleep — The Preparation of Barley-Water ; Advisability of 
Sterilization ; Quantity of Milk and Barley-Water for a One- 
Year-Old — The Value of Barley and Oatmeal Gruel — Harm- 
fulness of New Bread and Cookies — The Relative Merits of 
Graham and White Bread — Balls from Graham Flour — 



CONTENTS 

Graham, Oatmeal, and the Various Prepared Cereals — Honey 
and Molasses — Pop-Corn — Oatmeal Gruel as a Laxative — 
Is Oatmeal ' * Heating " ? — Incompatibility of Fruit and Milk — 
Strawberries at Four Years — Smuggling Milk into the Bill 
of Fare — Bananas, Apples, and Oranges — The Uses of Sage- 
Tea— The Abuse of Sugar — Breaking the "Bottle Habit"— 
Teaching Baby to Eat ; the Need of Water to Quench Thirst 
— Pure versus Diluted Milk at Two and a Half Years — But- 
termilk as Food for Children — Ice-Cream — Inordinate Fond- 
ness for Salt — Why Frozen Cream is Unsuitable Food — Uses 
of Fat in Foods — Variety in Food — The Effect of Tea on 
Children — Cocoa — Feeding a Premature Child — Butter and 
Eggs for a Child of Delicate Digestion — Proper Dilution of 
Condensed Milk — A '' Hard-Reared " Baby — Probable Over- 
Feeding ; Frequent Changes of Food ; Excessive Vomiting — 
Suggestions for Improving the Dietary in a Case of Slow Teeth- 
ing — Loss of Appetite; Imperfect Nutrition — Distaste for 
Meat. 



PART I 
THE GENERAL CARE OF CHILDREN 



THE CENTURY BOOK 
FOR MOTHERS 



THE PREPARATION FOR MOTHERHOOD 

IN one sense, the care of a child begins with its concep- 
tion. But the ante-natal care cannot be given directly 
to the unborn ; it must be bestowed upon the mother. What- 
ever she would do for its welfare must be performed through 
judicious care of her own health. Let it be understood at 
once that there is no special or patent regimen to be fol- 
lowed during pregnancy. Success attends the careful and 
common-sense application of the ordinary rules of health to 
the changed conditions that come with pregnancy. Just in 
proportion as the mother has previously led a hygienic life 
will the task be an easy one. If she has lived in neglect 
or defiance of hygiene, then she must ' ' cease to do evil, learn 
to do well." 

DIET 

The diet of pregnancy should be simple and nutritious, 
but should not, unless by reason of some special disorder, be 
different from the wholesome diet of a non-pregnant woman. 
The special restricted dietaries vaunted to insure easy de- 
livery have no such effect, and if the results claimed were 
really attained they would be merely a saving of some pain 
on the part of the mother at the expense of her infant's de- 
velopment. As there is a tendency to nausea, flatulence, and 

3 



4 THE CENTUEY BOOK FOR MOTHERS 

acidity with resulting heartburn, the diet should be not only 
nutritious but easily digestible. While the derangements 
just mentioned are most likely of nervous origin, there is 
no doubt that the digestive power is usually to some degree 
impaired. The use, therefore, of foods, such as sweets, pas- 
try, and rich articles generally, which are particularly likely 
to produce fermentation in any state of health, must tend 
to aggravate these unpleasant symptoms. 

There is a tendency during pregnancy to constipation, 
chiefly from mechanical pressure of the growing womb, or 
to the exaggeration of such a tendency if it already exists. 
To some degree this may be combated by the use of foods 
of a laxative tendency— fruits, coarse cereals, and all the 
usual articles employed Avith this intent. In the latter part 
of pregnancy, when the pressure of the womb upon the other 
abdominal organs becomes considerable, it is usually wise to 
moderate the amount of flesh diet, if it has been consider- 
able, and to supply its place with milk and eggs, in order 
that the tax upon the kidneys may be lessened. The free 
use of liquids— that is to say, of water or thin nutriment- 
is valuable, both as further helping the work of the kidneys 
and as favoring the proper action of the bowels. 



DRESS 

The dress of the pregnant woman must be entirely free 
from constriction. Very early in gestation the corset would 
better be abandoned, or, if worn at all, so loopely laced as 
to make no pressure. All of the organs, lungs, heart, stomach, 
bowels, not to mention the womb itself, demand the greatest 
freedom. There is a new and increased demand for oxy- 
gen: the lungs must take in more air, the heart and blood- 
vessels must convey a more unrestricted supply of the better 
oxygenated blood. All other sources of constriction, such 
as tight garments and bands, must be avoided. The garter 
deserves special mention, as in pregnancy there is a ten- 
dency to swelling of the veins of the lower extremities, and 



THE PREPARATION FOR MOTHERHOOD 5 

this is aggravated by a tight garter. Some other form of 
stocking support is preferable when the hose must be kept 
trimly in position. 

EXERCISE AND CLOTHING 

Am and exercise conduce to well-being in pregnancy as at 
other times. The amount of exercise that can be taken will 
vary very much with cases. The woman who does her own 
housework or any considerable part of it will not need exer- 
cise, for instance, but will need open air. A woman trou- 
bled badly with "morning sickness" may be unable for the 
time being to take outdoor exercise at all, but to her, as to 
all, air and sunshine will be beneficial, and it should be had 
if possible, even if it be no more than what can be got in 
the invalid's bedroom. Assuming that the woman is able 
to take exercise, how much shall she take? It must stop 
short of serious fatigue, and it must never be violent, lest, 
especially in those with a tendency in that direction, it favor 
or excite miscarriage. In a general way, exercise which 
gives a feeling of well-being and of only gentle weariness 
is beneficial and aids sleep. 

The customary use of the bath need not ordinarily be in- 
terrupted. It aids the functions of the skin, and is still 
another mode of assisting the kidneys in their functions. 
The action of the skin may be further assisted by suffi- 
ciently warm, but not burdensome, clothing, and the lower 
limbs especially need protection from chilling when the pro- 
tuberant abdomen prevents the usual clinging of the gar- 
ments about the person. Then the warmth of the garments 
next the skin should be increased. Many women dislike 
warm under-drawers, but their use at this time, if the 
weather be cold, is very desirable. 

DISCOMFORTS 

It is not easy to say at just what point the disturbances of 
functions usual in pregnancy cease to be normal and become 



6 THE CENTURY BOOK FOR MOTHERS 

disorders to be dealt with. Thus, a certain amount of 
''morning sickness" is so common as to be considered nor- 
mal, but this symptom may become so severe as to be dan- 
gerous. Whenever any of the ordinary functional disorders 
of pregnancy become really troublesome they are the proper 
care of the physician. Short of this point, it is desirable 
that the expectant mother should keep up a certain obser- 
vation of her own symptoms, without allowing herself to 
become at all hypochondriacal concerning them. Too much 
self -consideration is always harmful ; too little may occasion- 
ally be disadvantageous. In this spirit we may consider 
what may be done by domestic practice for some of the com- 
monest ailments of pregnancy. 

Nausea and vomiting, popularly called ''morning sick- 
ness," because of their usual occurrence at that time of day, 
are, as has just been said, almost always present at some time 
of pregnancy, especially in the earlier months. Sometimes 
salivation is associated with them or takes their place. Ordi- 
narily their severity is not so great as to demand the inter- 
ference of the physician, although they may sometimes tax 
his resources to the utmost. In the simpler cases the dis- 
comforts can be mitigated until the symptoms disappear, as 
they commonly do after the first three months, by attention 
to all the details of hygiene already suggested, and espe- 
cially those of feeding and rest. Thus, food should be given 
in small quantities at a time and proportionately often; 
easily digested forms of food, such as milk with lime-water 
or with effervescing waters, nutritious soups or meat ex- 
tracts, and the like, being chosen if the nausea is severe or 
persistent. Many patients, if they can remain absolutely 
quiet in bed until the middle of the forenoon, are able to 
pass the remainder of the day in comfort at their usual 
occupations. If the symptoms are more severe it may be 
necessary to keep the bed continuously for some time. 

Another symptom referred to the stomach is heart-burn, 
generally due to acidity. This is more persistent than nau- 
sea usually is, and is perhaps more severe in the later months. 



THE PREPARATION FOR MOTHERHOOD 7 

It is best met by antacids— that is to say, alkalis. Those 
most used are the familiar cubes of magnesium carbonate 
or other magnesia preparations, lime-water, sodium bicar- 
bonate, or the aromatic spirits of ammonia, both of the latter 
being dissolved in water when administered. 

The flatulence of pregnancy is best met by insuring regu- 
larity of the bowels and by correcting disordered conditions 
of the stomach. 

Constipation is to be combated by the same means as in 
the non-pregnant condition— namely, by mild laxatives, sup- 
positories, or enemata, in addition to the dietetic helps al- 
ready alluded to. 

Swollen veins in the loAver limbs are common. If not very 
severe they can be held in check by regulating the bowels 
and the wearing of some kind of elastic stocking if neces- 
sary. The avoiding of unnecessary standing when the pa- 
tient is not walking is useful, as is also the raising of the 
limbs whenever practicable. Similar care is advantageous 
to relieve effects of pressure elsewhere, as, for instance, upon 
the bladder, as evidenced by frequent calls to pass water. 

CARE OF THE BREASTS 

As pregnancy proceeds, progressive changes occur in the 
breasts and nipples. In many, perhaps most, cases no care 
is needed beyond the avoidance of pressure upon the parts, 
which is insured by ampleness of the garments covering 
them. Occasionally the nipples are so diminutive as to 
make it probable that the infant will have difficulty in seiz- 
ing them. In such cases it seems advantageous that the 
mother should gently draw or coax out the nipples with the 
fingers morning and evening during the later months of 
pregnancy. When the surface of the nipples is very tender 
and shows a tendency to crack or to become excoriated, it 
may usually be hardened by a daily application of some 
astringent. Among those commonly used are tannin and 
glycerin, twenty grains of the former to an ounce of the 



8 THE CENTURY BOOK FOR MOTHERS 

latter; alcohol and water, equal parts, with a little alum 
added; tincture of myrrh and the familiar preparations of 
witch-hazel. They should be applied with the finger or a 
soft camel's hair pencil. The nipples should be cleansed 
carefully with a bland soap, such as Castile, and warm water, 
and care should be taken to dry them very thoroughly before 
each application. 

THE MONTHLY NURSE 

One of the duties of the expectant mother, unless some 
friend relieves her of the task, is the selecting of a monthly 
nurse. The choice may be, in small places, a very limited 
one, and the selection practically forced. But in most large 
towns at the present time, since nursing has become a rec- 
ognized profession, quite a number of nurses are usually 
available. Two elements have to be considered in the nurse 
—her professional capability and her acceptability. Per- 
haps more often than not, the physician is not consulted 
as to the selection. The opinion of female friends as to the 
nurse's acceptability determines the question. And if the 
nurse selected is one Avho has graduated from a good train- 
ing-school, this method of selection is probably as good as 
any for ordinary cases. The physician might err upon the 
other side by considering only the nurse's skill. The Avriter, 
Avhen he is asked concerning a nurse, usually considers the 
circumstances of the household as well as the medical aspects 
of the case, and submits the names of several nurses likely 
to be suitable. The patient can then select that one most 
attractive to herself. The physician can generally learn 
pretty accurately the professional qualifications of the nurse. 
The elements that go to make up acceptability, which the 
physician may be acquainted with or which the patient or 
her friends may be able to learn about, are her diligence, her 
disposition and adaptability. Thus, a nurse may be entirely 
competent, but lazy, in which case details may not be prop- 
erly attended to. On the other hand— although this is a 
lesser evil— she may be something of a martinet, and attend 



THE PEEPARATION FOR MOTHERHOOD 9 

to her duties Avith a strictness which is tiresome and per- 
haps unnecessary. Her disposition tells in the ease with 
which she puts up with the necessary annoyances— and they 
are many— of the confinement chamber, and the tact with 
which she gets on with the servants, so that they cheerfully 
do the extra work put upon them. In the same way her 
general adaptability counts. Some nurses are excellent 
when all the resources of a wealthy family are at command; 
but are useless in cramped quarters. The tactful nurse fits 
in anywhere, in the luxurious mansion or the narrow apart- 
ment, and gives satisfaction above stairs and below stairs 
alike; and if she departs with the cook's good-will she may be 
accounted to have earned her blue ribbon. The greatest 
tax upon her tact will be the excluding, without giving 
offense, of obtrusive visitors, whose presence and conversa- 
tion in the lying-in chamber are often harmful to the patient 
and increase the anxiety of both nurse and physician. 

TIME OF CONFINEMENT 

The nurse having been selected, her first inquiry is likely 
to be, ' ' From what date do you wish to engage me ? " This 
opens the question of the duration of pregnancy. The vari- 
ations of its duration, like those of every natural process, 
are well known to medical men. Nevertheless, it is equally 
well known that when the facts relating to the probable 
beginning of pregnancy are accurately given, this variation 
is in the great majority of cases within pretty narrow limits. 
It is indeed surprising how frequently really intelligent 
women are unable to give the physician even the date of the 
last period. This is sometimes due to mere carelessness, 
sometimes to the substitution of a theory for a fact. Prac- 
tically there is but one method of reckoning— from the last 
menstrual period, the first day being used as the most cer- 
tain. When reckoning is made from this first day, the aver- 
age time to delivery is forty weeks, or two hundred and 
eighty days, which is Just ten ordinary menstrual intervals. 



10 THE CENTURY BOOK FOR MOTHERS 

When, as occasionally happens, a known elate of intercourse 
can be reckoned from, the duration is about thirty-nine 
weeks. It is very desirable, therefore, that the dates of the 
periods should be kept in some sort of a record, also that it 
be noted if there was any variation of the date or of the 
amount of flow. The reason for this last suggestion is this : 
If a pregnancy begins immediately before a period is due, 
that period may not be entirely prevented. It may be 
tardy, or, more likely, shortened very considerably. In such 
cases the delivery would be expected, not forty weeks from 
the beginning of the period, but about thirty-nine weeks 
from a date a little before the period. If the expectant 
mother has any facts of this nature it will be far better to 
let the physician know them frankly. It is wise also to 
keep note of the date when the motions of the child were 
first perceived, also when they were unmistakable, as these 
dates will help the physician to check off his calculations, 
especially in cases in which there is any uncertainty by the 
ordinary method of counting. Methods of ready reckoning, 
by tables or otherwise, are many. The best way, the writer 
believes, is for the patient to make sure of the facts and 
then lay them before her physician, whose familiarity with 
these reckonings makes the calculation easy. He can also dis- 
criminate between the dates which are certain and those 
which are approximate. 

The date of confinement having been settled as accurately 
as possible, the expectant mother is able to set the date 
from which she desires to engage the nurse. The old-fash- 
ioned term ''monthly nurse" expresses the period for which 
she is usually engaged, but if the patient's means permit 
and the nurse is acceptable, it is usually economy to keep 
her longer, until the mother's strength is entirely restored. 

THE OUTFIT OF THE LYING-IN CHAMBER 

It is usual, also, to settle with the nurse, if the physician 
has not given the necessary directions, what outfit shall be 



THE PREPARATION FOR MOTHERHOOD 11 

arranged for the lying-in. It is assumed that the lying-in 
chamber is the one most wholesome, airy, and sunny at com- 
mand, and that the bed has a good, comfortable mattress 
upon it. It should not be one upon which a person sick 
of any communicable disorder has lain, unless it has been 
thoroughly disinfected — preferably it should be one that has 
not been used by any sick person at all. The same must 
apply to the bedding. Certain arrangements for protect- 
ing the bed during and after delivery are necessary. These 
consist of a rubber sheet, over which some absorbent quilt 
or pad is laid. The rubber should be long enough to reach 
across the bed, AA^ith ends to fasten. A piece of rubber sheet- 
ing three yards long by two yards wide is to be procured. 
Cut it so that the larger piece is two yards square; the 
remainder is, of course, two yards long and one yard wide. 
The pads are made of some absorbent substance— commonly 
absorbent cotton, sometimes wood-pulp — covered with a light, 
porous fabric, such as cheese-cloth. Of these at least three, 
preferably four, are required. Two feet square is a con- 
venient size, although the writer prefers one rather larger, 
say a yard square, for the actual delivery. 

The nurse usually makes the bed, but in her absence any 
one can do it properly by noting the folloAving: First pin 
the larger rubber sheet over the mattress, completely cover- 
ing the latter. Then put on the bottom sheet. Next put 
the narrower rubber sheet across the middle of the bed and 
cover it with a draw-sheet. On this place one of the pads, 
the larger if there be one. Under ordinary circumstances, 
only a pad, or the draw-sheet at most, will be soiled, and 
when these are withdrawn the patient will have a perfectly 
dry and comfortable bed beneath her. 

In addition she will need four dozen pads to be used as 
napkins to the vulva. They are made of the same material 
as the bed-pads, but of appropriate shape and size. Two 
binders or abdominal bandages are to be provided. They 
should be long enough to go one and one third times about 
the hips, and wide enough to reach from the lower margin 



12 THE CENTURY BOOK FOR MOTHERS 

of the ribs to the genitals. Shaped binders are sometimes 
made, but a skilful nurse will pin a straight strip of muslin 
so that it will fit the person better than any bandage pre- 
viously modeled when the figure is very different. 

For the use of the physician at the time of delivery and 
of the nurse afterward, quite a number of articles, drugs, 
and surgical dressings are needed. Those which the physi- 
cian may need he may have in his obstetrical bag, but in 
cities most women prefer to get them in advance, especially 
the anesthetics, so that they are surely at hand in case the 
physician should be so suddenly called that he cannot go 
for his bag, or for any other reason should not have the 
desired articles. 

The drugs are ether or chloroform, or both, ergot in some 
form, and some good spirits, brandy or whisky. The physi- 
cian will also need some disinfectants. Nearly all these 
drugs, being poison, can be had, in some States at least, only 
on prescription, and it is best to arrange Avith the phj^sician 
whether or not the patient shall procure them, and, if so, 
he will give the necessary prescriptions. The disinfectants 
needed are usually bichlorid-of-mercury tablets, a bottle 
containing twenty-five; carbolic acid, the deliquesced crys- 
tals, four ounces ; boric acid, powder two ounces and crystals 
eight ounces— the crystals are less troublesome to dissolve, 
as the powder floats; but for some purposes the latter is 
preferable, hence both are often ordered. 

Other things usually ordered are the following: A rubber 
douche-bag, often called a fountain syringe, to hold three 
quarts; two glass nozzles for the same; one square douche- 
pan of agate-ware ; three basins of agate-ware or paper, the 
latter being the lighter; one rubber catheter; one glass ca- 
theter; one glass syringe; one pound of absorbent cotton 
(also, to be made of this cotton, two dozen mops to take the 
place of sponges, except for the personal toilet, for which 
the usual large and small sponges are provided) ; two tubes 
of white vaseline; three papers of safety-pins; ordinary 
pins ; one cake of Castile soap ; one skein of bobbin, from 



THE PREPARATION FOR MOTHERHOOD 13 

which, in advance of need, the nurse will cut four pieces 
ten or twelve inches long. Lastly, a tube containing iodo- 
form gauze is often convenient, and so is a sterilized nail- 
brush in a tube, to be used for disinfection. 

Some of these things may be already in the house. They 
should in that case be made "surgically clean" by washing 
and heat. Many of the articles in the list, those of rubber 
and glass especially, can be boiled without harm. The dry 
dressings can be sterilized by the heat of a moderately hot 
oven — one in which a pan of Avater would simmer or boil 
lightly will be quite hot enough. If the nurse be in the house 
in time, she will attend to details, and in any case all the 
necessary things to be provided in advance should be 
wrapped carefully and put where they can be found at once. 
Besides the things to be bought there will be needed a dozen 
and a half towels old enough to be soft. These are to be 
put away with the other supplies. At the approach of labor, 
orders should at once be given that the tires be kept up, so 
that abundance of hot water may be had; and also that 
a good supply of ice be on hand, as accidents may occur in 
which both are much needed. 



THE BABY BASKET 

Probably long before the expectant mother has made the 
preparations hitherto described, she will have been getting 
ready all the dainty outfit of the baby. So much of taste 
and of maternal solicitude has from time immemorial gone 
into the making of baby clothes that one might wish to 
leave the subject in that realm of esthetic sentiment. The 
consideration of it must nevertheless take its place with the 
rest that concerns the infant. 

The subject of the infant's clothing would better be joined 
to that of clothing for children in general, and will be de- 
ferred for that chapter. In this place will be mentioned 
only things needed for the baby's first toilet. These are 
the baby basket and its contents and the baby's bath-tub. 



14 THE CENTURY BOOK FOR MOTHERS 

With the growth of luxury the baby's basket has developed 
from the ancient little wicker basket into a great variety 
and choice, from simple lined and draped baskets to those 
upon legs, those of hamper shape with a tray which con- 
stitutes the real basket, as well as a great number of variants 
of these patterns to be found in the shops of cities. The 
essential is the basket to keep together the toilet articles. 
The linings and coverings are expressions of taste. The 
smaller, simple basket has the advantage of taking less room ; 
the basket on legs, a basket-stand, is most convenient, being 
of comfortable height, and saving a great deal of stooping, 
which is awkward for one holding an infant in the lap. If 
room or money cannot well be spared for this pattern, the 
common basket, when in use, should be placed upon a chair 
or other suitable support. The hamper pattern seems to 
the writer to have no real advantage, except as an oppor- 
tunity for the display of taste. The lower part of the ham- 
per can only be used to hold clothing. This has some ad- 
vantages, but also has the disadvantages of ''living in a 
trunk." Whatever pattern is chosen, it is convenient to 
have in its lining various pockets, and to have fixed to it 
several cushions for pins and the like. It is necessary that 
this basket contain at the time of labor a number of things 
which will then be needed. They are : 

Safety-pins of various sizes. 

Common pins. 

A small roll of absorbent cotton. 

A number of the cotton mops spoken of. 

Vaseline, in tubes, even at the cost of displacing the orna- 
mental vaseline-jar. 

Soap in a suitable closed box or jar; glass, celluloid, and 
metal are all used. The first is perhaps the best. 

A baby's hair-brush. 

A fine-toothed baby comb is sometimes added. 

A very soft, fine sponge and a wash-cloth of some very 
soft old material for cleansing folds and crevices. 

A powder-box and puff are usual and sometimes useful. 



THE PREPARATION FOR MOTHERHOOD 15 

Over these two or three towels. 

Over the whole basket an old soft wrap, usually an old 
blanket, is laid for the reception of the baby, and on top 
of all the cut pieces of bobbin, and, if the nurse has not her 
own scissors by her, a stout pair of scissors. 

Besides all these things, a suit of the clothes selected is 
made ready. It may be placed in the basket, or the articles 
may be laid, in the reverse order of their use (that is, that 
to be put on the child last is put on the towel first), upon a 
clean towel in some convenient place. 

PREPARATIONS FOR THE BATH 

The bath-tubs in commonest use are the baby's tin bath-tub 
or the tin foot-tub used for adults. These will serve well 
enough if placed upon two chairs or upon a bench to raise 
them to a convenient height. It is easy to contrive ways in 
which they may be used in connection with the usual bath- 
room fixtures. But no tub that we have seen has as many 
advantages as the bath-tub made of a rubber sheet fastened 
to a folding-frame, made in imitation of the ancient cross- 
legged cot bedstead. These are sold in shops, and cost about 
seven dollars, but they are easily made. A carpenter can 
make the folding-frame. A strong band of webbing con- 
nects the longitudinal bars at either end. The rubber is 
tacked to the bars and stitched to the webbing, and the 
whole is complete. Those sold in the shops are often made 
to ''knock down," so that they can be folded up, making a 
parcel which would slip into a carrier for golf-clubs. But 
this is not essential, unless for a family of very migratory 
habits. The shops in great cities are full of contrivances 
more or less convenient for the baby's toilet. The writer 
has endeavored only to mention those necessary or most 
desirable. 

The soap for the bath should be bland, one of the super- 
fatted ones being pretty certain to be unirritating. Castile 
soap of good quality has stood the tests of generations. 



16 THE CENTURY BOOK FOR MOTHERS 

The sponges must be very fine and soft, and have been 
completely freed from sand. Besides the cleansing which 
has been given the sponge before it is sold at the pharma- 
cist's, the mother would do well to spend some time in soak- 
ing it and examining it for hard substances, which are sur- 
prisingly penetrating even to an adult's skin. These cling 
closely to the tissues of the sponge, and must be torn or cut 
away. 

PRECAUTIONS FOR THE MOTHER 

The physician will probably ask for a specimen of the preg- 
nant woman's urine by the time she has advanced to the 
fifth or sixth month. If, in the pressure of his work, he has 
forgotten to do so, she should send to him a vial of urine, 
say four ounces, plainly marked with her name and the 
date of the passing of the water, with a note asking how 
frequently he desires subsequent specimens. He will be 
grateful for the reminder, as by these specimens he can be 
warned if there be any evidence of damage to the kidneys. 



THE VALUE OF A CHEERFUL FRAME OF MIND 

Having, as far as practicable, attended to her own health, 
having engaged her nurse and made all necessary provision 
for the needs of the lying-in and for the infant, the mother 
ought to look forward to her delivery with confident cheer- 
fulness. Yet the pregnant condition often begets a depres- 
sion of spirits, and the delivery is looked forward to as a 
time of extreme peril rather than as one of triumphant strug- 
gle. This state should be combated, not only by the patient 
herself, but by all her intimate friends. Nevertheless there 
are persons— it is difficult to find any civil name for them— 
whose morbid joy it is to visit expectant mothers, especially 
those pregnant for the first time, and detail to them all the 
difficult or disastrous labors they have heard of, usually 
with many gruesome exaggerations of their own. Such per- 
sons cause a deal of unnecessary anxiety and suflt'ering. The 



THE PREPARATION FOR MOTHERHOOD 17 

answer to their croakings is this: that while sad cases do 
occur, and will occur again, universal experience shows that 
the immense majority of children come into the Avorld with 
safety to themselves and their mothers, and that what was 
said of old is true to-day: ''As soon as she is delivered of 
the child, she remembereth no more the anguish, for joy 
that a man is born into the world/' 



II 

THE NURSERY 

IN what is written below, the nursery is understood to 
be that room or those rooms in which young children, 
and especially the baby, spend most of their indoor hours. 
In describing the requirements of a nursery, it must be 
assumed that the mother is free to choose and arrange as 
she will. But it is also borne in mind that means, occupa- 
tion, and situation determine to a great degree the extent 
to which nursery ideals may be attained. This book is 
not meant for the rich or even the well-to-do alone, and it 
is hoped that those of limited means may find, in the descrip- 
tion of what a nursery should be, hints which will enable 
them to make the apartment of their little ones wholesome 
while inexpensive. Whatever the home into which the baby 
comes, the newcomer is entitled to its best room — not merely 
because it is the long-expected guest, but because just in pro- 
portion to its youth is it susceptible to the influence of its 
surroundings for good or evil. Adults may tolerate rooms, 
may even thrive in them, which would debilitate, if not 
destroy, a young child. 

LIGHT AND AIR 

Three things are of prime necessity for the nursery— sun- 
shine, air, and dryness. These are requisite for both the 
day nursery and the night nursery. If the mother's bed- 
room must be the night nursery, or if the family living-room 
must be the day nursery, then these rooms should, as far as 

18 



THE NURSERY 19 

practicable, be selected with reference to the needs of a nur- 
sery. To insure sunshine, of course the south is the best 
exposure; next to it, we think, in this climate, is the east, 
as the morning sunshine coincides better with the child's 
waking hours than that of the afternoon; in other respects 
the western sun is practically as good. So valuable is the 
sunshine as a purifier that even in summer a sunny room, 
although it may have to be screened with shades or awnings, 
is better than one into which sunshine does not come. The 
air-supply must be pure in quality and adequate in quan- 
tity, and the apartment must be as dry as possible. All 
three of these main requirements— sun, air, and dryness— 
are better satisfied in a room well elevated from the ground : 
an up-stairs room being best, but not one under the roof, 
which would feel changes of heat and cold in an exagger- 
ated degree. 

VENTILATION AND HEATING 

The question of ventilation involves not only the air-supj^y, 
but the getting out of the foul air. There is no necessary 
connection between it and the problem of heating; never- 
theless the apparatus generally employed for heating our 
houses is in cold Aveather very largely concerned in the 
change of air in the rooms. Our common methods of heat- 
ing are much more satisfactory than our ventilation, and 
in ordinary houses the ingress of fresh air is much better 
provided for than is the egress of vitiated air. 

The most ancient form of heating apparatus is the open 
fireplace. It is very wasteful of heat, heats the room un- 
evenly, but is admirable for ventilation. In fact, even a 
furnace-warmed room in which there is an open fireplace 
is likely to be fairly well ventilated. But its ventilating 
power and its unequal heating make it a great producer of 
drafts, and the floor in its vicinity is a dangerous place for 
a child in a room so heated. The danger to children from 
the fire can be guarded against by a high wire fender fas- 
tened in place by some adjustable contrivance. 



20 THE CENTURY BOOK FOR MOTHERS 

The next is the box or ^' air-tight" stove, which is a pow- 
erful heater, but makes no provision for ventilation. It 
needs a guard to prevent burns, much as does the open fire. 
The Franklin stove was invented to save heat while preserv- 
ing some of the advantages of the open fire, and is a fair 
sort of compromise. There are various kinds of jacketed 
stoves with a cold-air supply from out of doors, quite satis- 
factory for very large rooms, but not very practicable for 
ordinary houses. 

If the fireplace, stove, or Franklin is used, the supply of 
fresh air practically comes from the windows and doors by 
penetrating through the cracks, unless some arrangement be 
made to admit it more systematically. Various patented 
devices for window-boards are in use, such as the elbow- 
tubes, which throw the air-current directly upward, which 
is unobjectionable. But it is not certain that they have 
real advantages over the old-fashioned, simple window-board, 
two forms of which are common. One consists of a stout 
bc^rd, about four inches wide, which fits into the window- 
frame, the bottom of the lower sash resting upon it snugly. 
The upper edge of this board may be Covered with felt to 
insure neater contact. The sash being thus raised, air enters 
at its junction with the upper sash, the current being di- 
rected upward, and the fresh, cool air is gradually diffused 
about the room, instead of entering as a horizontal and prob- 
ably injurious draft. The other form of the board differs 
from that just described only in being somewhat wider, six 
to eight inches, and being placed against the sash, felt being 
interposed if desired. By this arrangement the lower sash 
may be raised so that its bottom nearly reaches the top of 
the board or to any less height, or it may be closed com- 
pletely at will. 

In towns generally, and in many country houses, some 
form of furnace heating is employed, alone or in combina- 
tion with fireplaces. The commonest as well as the oldest 
type is the hot-air furnace. Steam and hot-water heating are 



THE NURSERY 21 

more recent and relatively infrequent. Electric heating at 
the present time is hardly introduced into private houses. 
The common hot-air furnace has the advantage that the air 
to be heated is drawn from out of doors, and with very 
simple precautions can be made fairly pure. These precau- 
tions consist in taking the cold air at a height above the 
ground surface, as may be easily done by carrying the end 
of the flue up from six to ten feet and reversing its extremity, 
so that neither rain nor dirt shall fall into it. The open end 
should be protected by a wire screen, to prevent things being 
thrown in or animals crawling in. One common defect is 
that the furnace is so arranged or so managed that it delivers 
a small quantity of very hot air, whereas a larger volume 
of air not so highly heated would be more advantageous. 
Of the other types the hot-water seems the more manageable, 
but neither has any necessary connection with air-supply. 

It will be noticed that none of these plans of heating, except 
the open fire, includes any plan of getting rid of the vitiated 
air. If an open fireplace exists and the registers for hot air 
be placed high on the wall, a very satisfactory form of "base 
ventilation" exists. If no fireplace exists and no system of 
ventilation was included in the building of the house, it is 
very difficult to keep the air of the nursery sweet, except 
by constant attention to the airing of the room. A device 
which is not very expensive can be employed if there be a 
chimney accessible. It is to carry a ventilating-pipe, the 
mouth of which is near the floor of the nursery, into and for 
some distance up the chimney-flue. The heat of the chim- 
ney creates a current of air upward in the pipe, which is 
replaced by the air from the nursery. If the pipe can be 
carried to the roof it need only be against the chimney and 
not be within it. 

Gas-stoves should never be used, as they vitiate an enor- 
mous amount of air, unless they are set, like a "gas-log," 
into the fireplace, where their combustion products can 
escape up the chimney. 



22 THE CENTURY BOOK FOR MOTHERS 

THE PROPER TEMPERATURE 

The temperature of the nursery is usually much too high. 
It should not be higher than 70° F. If uniformity could be 
secured, probably 65° F. would be sufficiently high. The 
night temperature should remain as near to the latter figure 
as practicable, but, despite great care, the temperature will 
often fall in the latter part of the night. A source of chill 
ought to be mentioned— namely, the windows; not through 
ingress of air from without, but by the rapid cooling of 
air next the glass, which pours down upon the floor to in- 
crease the drafts of the room. If the child's bed is unavoid- 
ably near a window, in cool weather it should be especially 
protected by screens; and it is well to make the window 
inaccessible to the young children by placing before it some 
piece of furniture not high enough to obstruct light or dimin- 
ish its usefulness. 

LIGHTS 

Unfortunately, the same objection made against gas-stoves 
must be made to some degree to all lights, except the elec- 
tric, and this is usually too bright for anything but full 
illumination. A large gas-flame or kerosene-lamp consumes 
as much oxygen as five or six adults in the room would. 
Small lights, therefore, are to be used, except when large 
ones are really necessary. The lamp or gas can be utilized, 
however, to favor ventilation, if a ventilating-pipe as just 
described exists, by having its open end wide enough so 
that the lamp or burner may be placed beneath it. 

The most convenient portable night light which we know 
is that called the ''Pyramid Night Light." It is a short, 
stout candle in a plaster-of -Paris base. This fits a metallic 
stand, and is covered by a shade or chimney of truncated 
conical shape. It will burn long enough to last from the 
mother's ordinary bedtime until daylight. The old-fash- 
ioned floating night light is obsolete. There are made also 
small kerosene-lamps which burn with a very small flame. 



THE NURSERY 23 

If the flame is carefully adjusted so that it burns without 
odor, they serve very well- if not, these lamps are unsuit- 
able to the nursery. 

NURSERY FURNISHINGS 

Windows should have guards within or without, to prevent 
a child from falling out ; and blinds or dark shades, to tem- 
per the light, are necessary. Similar guards should be at 
the doors or stair-heads when the children are large enough 
to run about. 

Since in most houses the nursery must, in case of any 
sickness, be the hospital as well, some parts of its structure 
and all of its furnishing must be in conformity to this pos- 
sible use. Its floor must be smooth, so that it can be made 
clean and kept clean. It is best made of narrow, hardwood 
boards well and closely laid, the cracks filled with putty or 
some of the preparations made for the purpose, and well 
varnished. Cheap carpets in rug form are best. The walls 
are best painted; if papered it should be with some of the 
varnished washable papers often used in bath-rooms. Every- 
thing should be plain and substantial and with as few dirt- 
catching recesses as possible. Everything, in fact, in a nur- 
sery should be selected after considering two questions: 
Can it be kept thoroughly clean or completely disinfected 
if contaminated? and, Can I afford to destroy it if I can- 
not make it entirely pure ? 

For these reasons the furniture should be devoid of orna- 
ment. The bedsteads are best of metal, those of painted 
iron having most advantages; the design known as the hos- 
pital pattern is probably best of all. There should be no 
curtains save such as can be boiled or steamed. The mat- 
tress and pillow should be of good hair, and the former pro- 
tected from wetting or soiling by a rubber sheet. Of course, 
the child's bed, if possible, should not be shared by an adult, 
and the child should either have its own bureau or cup- 
board, or at least its own drawers in the bureau. Save for 



24 THE CENTURY BOOK FOR MOTHERS 

the turmoil and disarrangement of ''sweeping days," an 
open cupboard of shelves closed with a curtain would prob- 
ably be kept in better order than any device shut up from 
inspection. In any case, these necessary receptacles should 
be arranged so as to be kept clean and aired with the least 
trouble. Hence shelves Avithin easy reach and not far apart, 
so that many things are not necessarily put into one pile, 
are better than inaccessible drawers. 

The same reasons of cleanliness, not to mention possibili- 
ties of infection, make it advisable that there should be no 
plumbing in the nursery, and that the latter should not 
connect with, and preferably should not be near to, a water- 
closet or even a bath-room. The convenience of such near- 
ness is often dearly paid for. 

The furniture, other than the bedstead, cannot well be of 
metal, and should be carefully selected according to the 
simple rules just given. Chairs of plain and solid structure 
—for instance, of bent wood and with cane seats— are far 
preferable to those of ornamental design, of wickerwork, or 
upholstered. 

Thus far nothing has been said concerning a day nursery. 
If one can be afforded as well as a night nursery, so much 
the better. In that case its sanitary arrangements will be 
the same as those described for the nursery of all work. If 
the child is to sleep with its mother, then the nursery be- 
comes a day nursery, and the mother's bedroom must be 
arranged on a plan to suit the needs of a night nursery. 



Ill 

THE NEW BABY 

WHEN the infant has been delivered— has manifested 
its presence most probably by loud cries— the physi- 
cian ties the cord, divides it, and lays the child, warmly 
wrapped in the blanket provided, aside in a safe place, while 
he attends to the safety and comfort of the mother. When 
at length he can properly do so, he returns to the infant, 
and quickly and carefully inspects it to ascertain if it be 
normal in development, whether there be defects or blem- 
ishes. Those first looked for are usually defects the existence 
of which would imperil its life or hinder its nutrition, and 
these are especially imperforate anus, defects or obstructions 
of the urinary organs, and harelip. The latter interferes 
directly with sucking, hence with the nutrition of the babe ; 
the anal obstruction, if not relieved by surgery, must soon 
destroy the child; while the urinary organs, being more 
often imperfect than obstructed, are less likely to threaten 
the existence of the child through their defects, and do not 
need such immediate surgical attention. He will notice, 
also, if they exist, striking moles, supernumerary fingers, or 
club-feet. These deformities or defects are the physician's 
particular care. He will judge, as to moles, whether or not 
they can be removed, as to supernumerary digits, the proper 
time for their removal, and will as soon as possible instruct 
the nurse in the proper manipulations which favor the cure 
of club-foot. 

25 



26 THE CENTURY BOOK FOR MOTHERS 



BABY'S FIRST BATH 

Fortunately, all these deformities, although more common 
than others, are relatively rare, and the cares of the nurse 
are usually only those which every healthy baby demands. 
Baby's first bath involves a little more detail than its sub- 
sequent ablutions, and it may be described Avith advantage. 
This bath cannot, of course, be given by the mother, but it 
may be useful for her to know its method.^ 

The nurse has already gathered about the fire or the source 
of heat in the room the necessary utensils— tub, towels, soap, 
hot and cold water, oil or some kind of grease, powder, and 
the child's garments. She puts on a flannel apron or lays 
over her lap a thin soft blanket. She takes the child in 
its wraps and sits in a low chair, with the baby in her lap. 
As the wraps are removed the child's body is found to be 
partly or wholly covered with a greasy, pasty substance 
called vernix caseosa, meaning cheesy varnish. The amount 
of this varies considerably in different children. Into this 
the grease is well rubbed before washing. Vaseline is nowa- 
days most commonly used, but lard or oil is at least equally 
good. The grease is rubbed thoroughly but gently all over 
the body, and with especial care into the armpits, the groins, 
around the genitals, and into every crease or fold of the 
skin. If the varnish is very tough or adhesive, or if the 
child be not very strong, the washing may be deferred, the 
child, after the inunction, being again rolled up warmly and 
left to rest. Ordinarily, however, the bathing immediately 
follows. 

The cheesy matter loosened by the grease is wiped off 
with a soft cloth or the wrapping-sheet, and then every part 
is carefully washed with soap and water. The child before 

1 It may be mentioned tliat some head, protecting it until the time 

physicians,at least in hospital prac- at which it is to be washed. But 

tice, prefer not to wash the infant the detail of the first bath remains 

at once, but place it in a warm the same whenever it is given, 
bag, which covers it, except the 



THE NEW BABY 27 

birth had been kept in a surrounding medium at about a 
temperature of 100° F., and that of the bath should be prac- 
tically the same. Cheap bath-thermometers are everywhere 
to be had nowadays. An ancient traditional substitute was 
the elbow of the nurse's bared arm, which is more sensitive 
than her hand. After thorough soaping the child is im- 
mersed for a few moments in the bath at the temperature of 
from 98° to 100° F. It is sometimes convenient to do the pre- 
liminary lathering with the aid of a basin separate from the 
tub, but it is not necessary. As it is often necessary to 
spend quite a little time in cleaning out the folds and creases, 
it is better that only that part of the body which is being 
cleansed should be exposed at one time. In the immersion 
of the child a little dexterity is required to prevent the 
child's slipping from the hands. The usual manoeuver is 
this: The child's head and shoulders are supported upon 
the nurse's left palm and wrist, the first and second fingers 
of that hand go into the farther armpit (i. e., the baby's 
left), while the thumb steadies the shoulder. The nurse's 
right hand supports and grasps the lower part of the baby's 
thighs and knees. The child is raised from the lap and slid 
into the water, the left hand continuing to support the head 
above the water. The right may assist in the rinsing if 
necessary. The child is then lifted back into the lap and 
dried very carefully with a large, soft towel, which should 
envelop the baby during the process. If, as is usual, there 
be an admiring spectator of this first bath, she can assist by 
laying this towel upon the nurse's lap in advance. All the 
folds before mentioned must be dried most carefully. If it 
be well and thoroughly done, toilet-powder is not necessary, 
but it is admissible, and its use is preferable to the leaving of 
any dampness, the function of powder being only as a drier. 

SPECIAL PRECAUTIONS 

Two or three points should be especially mentioned in con- 
nection with the bath— namely, the cleansing of the scalp. 



28 THE CENTURY BOOK: FOR MOTHERS 

of the eyes, ears, nose, and mouth, and the care of the navel. 
The scalp differs from the rest of the surface only in that 
it demands more care in many cases to keep it clean. The 
eyes should be very carefully cleaned even before the bath, 
and nurses trained in hospitals often wash the eyes with a 
solution of boric acid as soon as the physician hands them 
the baby. In many lying-in hospitals it is customary to make 
a still stronger application, such as a solution of a salt of 
silver, to the eyes of the new-born as a preventive of infec- 
tion from the mother's passages at the time of birth. This 
detail is not generally adopted as a routine in private prac- 
tice. The ears should have especial care, owing to the many 
places where dirt may linger; and the nose should be care- 
fully freed from discharges, which may subsequently prove 
irritating. The mouth must be cleansed, not only at this 
first bath, but, like the eyes, at every bath, with a separate 
bit of rag or absorbent cotton, either with pure cold water 
(preferably water which has been boiled) or with a solution 
of boric acid. 

THE NAVEL-STRING 

The piece of the umbilical cord, or navel-string, between the 
point where it Avas tied and the navel itself, separates natu- 
rally from the navel about the fifth day. During the inter- 
vening time the moisture from it soils the wrappings or gar- 
ments, and may smell unpleasantly from decomposition. 
Various devices have been employed to combat this, from the 
traditional antiseptic of burned linen down. At the present 
time there seems to be no method more generally applicable 
or advantageous than to envelop the piece of cord, doubled 
upon itself if it be long enough, with a fair-sized wad of 
absorbent cotton, taking pains to cover smoothly all the cord. 
This absorbent cotton takes up the moisture as it exudes, 
and any disagreeable odor can be prevented by dusting the 
cord with a little boric acid or salicylic acid at the first dress- 
ing, and dusting the cotton at the daily bath if necessary. 
The whole is kept in place by the flannel band usually placed 



THE NEW BABY 29 

around the child's abdomen. The cord is usually dressed 
upon the left side, the reason assigned being that thus pres- 
sure upon the large liver is avoided. When the cord falls 
off a small raw surface remains, which heals in a few days 
if simply kept dry. If slow in healing or inclined to be 
moist it may be dusted A\dth a little bismuth powder, the 
subgallate being the preferable preparation. Some physi- 
cians prefer a mixture of starch powder and salicylic acid, 
which is likewise a drying and antiseptic preparation. Im- 
mersion baths are not repeated until after the cord has 
dropped off, daily sponge-baths of simple water being 
enough. After the separation the tub may be resumed if 
the child is of average strength. Besides the daily bath, 
sponging of the soiled parts is necessary whenever the nap- 
kins are changed. 



IV 
NURSERY ROUTINE 

AFTER the monthly nurse leaves the mother's condition 
J\^ suddenly changes from that of one closely cared for to 
that of a caretaker. If she has had the good fortune to 
have one of those nurses who are not only competent to do 
their work well, but facile in teaching others, the beginning 
of the task will not be difficult. At all events, if the mother 
has been watchful and observant she should know pretty 
wxll what is to be done. Her chief cares will be not to 
carry her task too anxiously, and to do her work in such a 
way as shall not only meet the child's immediate needs, but 
train it into good habits. These needs are born with the 
child, its habits are to be acquired; and it is probable that 
during the nurse's incumbency most of the infant's func- 
tions have been regulated and many of its habits already 
formed. If these habits are good, the mother's task will be 
easy; if not, the correcting them will increase her burden. 
Habits are good when the needs of life are met in a regular 
and desirable way, and ordinarily they are as easily formed 
in the right direction as the wrong, if a little thought be 
taken and forethought used. 

HOURS OF SLEEP 

The new infant's life is essentially one of eating and sleep- 
ing. In its earlier weeks, probably it is a^vake not more than 
two hours in the twenty-four, and this may still be the case 
when the nurse leaves. Three hours will certainly cover 
its waking time, which is divided into portions of from a 

30 



NURSERY ROUTINE 31 

quarter of an hour to an hour, unless possibly its morning 
bath may keep it awake longer at that time of day. 

The waking hours gradually increase, so that at six months 
they may amount to six or even more hours in the day. At a 
year, a long morning nap and a short one after noon are 
usual, besides an all-night's sleep. And the practice of a 
daily nap should be encouraged as long as possible. Some 
healthy children continue it until six or seven years of age, 
and some, equally healthy, are too active to take a day nap 
after three years. Now, the infant whose needs— warmth, 
food, and quiet — are supplied, will sleep, and nothing more is 
needed. Doubtless the habit of rocking or cuddling a child 
to sleep begins through tenderness, but it presently becomes 
a bondage ; and many of the methods employed — thumb-suck- 
ing, sugar-teats, rubber nipples, etc. — are objectionable at 
the very least, and often injurious. The writer has knoAvn 
some children of ten or more years who still required some 
absurd device to induce sleep. When, therefore, the child 
has been dressed, bathed, or fed, according to whichever 
may at the time be due, it should be placed in a comfortable 
position in its bed and let alone. Obviously, it is better both 
for the parents and for the child, after a little time, that its 
sleeping and waking hours should correspond as far as prac- 
ticable with those of adults. So the infant should not be 
allowed to sleep indefinitely and wake irregularly, but should 
be wakened regularly at the hours of feeding, and again put 
to rest through the day, and at night be allowed to sleep at 
a time so long as may be thought proper for its age, which 
is practically as long as it will sleep, or as the fullness of the 
mother's breast will permit. At night the intervals of wak- 
ing are at first about twice as far apart as the day wakings. 
So that, assuming that when the nurse leaves the baby is 
suckled or fed every two and one half hours during the day, 
it will go five hours at night, which will give but one meal 
between the mother's bedtime and her time of rising. This 
night meal is usually too long continued. It is not necessary 
after the child is five, or at most six, months of age. The 



32 THE CENTURY BOOK FOR MOTHERS 

child's sleeping hours are therefore largely conditioned by 
the times of feeding; and if the breast supply is adequate 
or the artificial food properly adjusted, the hours of sleep, 
if the child be in health, should take care of themselves. 
The regularity of habits regarding sleep has another advan- 
tage, which may be here mentioned, although its value is 
greater later than in infancy. Hours of rest, even without 
sleep, are exceedingly valuable to active children, and, above 
all, to those of excitable nervous system. If the sleeping 
times have been regular, and the child is accustomed to being 
put to bed without any of the artificial inducers of sleep 
before alluded to, it is easy to make it lie down and rest 
or amuse itself with some unexciting toy or book, if it be 
old enough, while without regular habits the attempt would 
be only a vexation to all concerned. 

The amount of sleep needed will vary somewhat with chil- 
dren ; yet in a general way it is true, as long since pointed 
out, that the child who sleeps well thrives— that is to say, 
its functions are well performed, its nutrition satisfactorj^ 
and its wear and tear easily repaired. As has been said, the 
infant sleeps about all the time, unless waking for a definite 
X)urpose, such as feeding or its toilet. A year-old child 
sleeps more than half the time. Up to three or four years, 
probably twelve hours in the twenty- four would not be much 
above the average, and until puberty it is well to try to 
give a child ten hours of sleep daily. 

DISTURBED SLEEP 

Disorders of sleep are not common in infancy, nor in child- 
hood are they as frequent as in adult life. In infancy dis- 
turbances of sleep generally take the form of restlessness and 
sometimes of dreams. Usually some pain or distinct trouble 
or discomfort may be found as the cause, such as the uneasi- 
ness, direct or reflex, caused by dentition, by earaches, con- 
stipation, indigestion, or overfeeding, or the general disturb- 
ance accompanying any febrile condition. 



NURSERY ROUTINE 33 

After infancy disturbances are more common, and that 
one concerning which physicians are more consulted per- 
haps than any other — namely, night terrors — is most fre- 
quent, say, from three to six years of age. This affection is 
distressing to see. The child is usually found sitting or cow- 
ering, often shrieking, sometimes covered with the sweat of 
terror, and shrinking from some object of horror. This may 
be something definite, some person or beast, or some other 
thing of which it is in great dread. Quite as commonly the 
terror is of something which it cannot or does not indicate. 
The most distressing feature to the parent or nurse is that 
the child very likely does not recognize it, and refuses the 
proffered comfort. As complete consciousness returns, rec- 
ognition returns with it and the reassurances are accepted, 
and before long the child goes into a sound sleep of weari- 
ness. The attack is rarely repeated the same night, nor is 
it usual that they come in successive nights. Ordinarily 
there is quite an interval. 

The causes of such attacks are often quite clearly recog- 
nized, sometimes, however, not at all. In the first place, the 
children who are subject to them are usually— not always— 
delicate, feeble, or nervous. Again, more often than not, 
some physical irritation, especially of the digestive organs, 
may be recognized ; or there is the story of alarming occur- 
rences in the daytime, or exciting or injudicious story-telling 
before the child is put to bed. Any error of physical or 
mental hygiene may be the exciting cause. Nevertheless 
cases do occur in which no causation can be certainly 
found. 

A few of these cases prove to be nocturnal epilepsy, and 
a few others to be manifestations of cerebral troubles of one 
sort or another. As a rule, however, the peculiarity passes 
away either by the diminution of the peculiar susceptibility 
or the removal of the exciting causes. 

It will be noticed that the condition known in adults as 
nightmare and rarely seen in children, lies between the com- 
mon dreams and this more distressing malady. Also akin 

3 



34 THE CENTURY BOOK FOR MOTHERS 

to it are sleep-walking and similar manifestations of activity 
during sleep. 

As to cure, the efforts of the parent, with medical assistance 
if necessary, must be directed to the strengthening and im- 
proving of the general condition of the child and the remov- 
ing and preventing of all recognizable sources of irritation. 

SUCKLING 

The question of artificial feeding is such a wide one that it 
will be deferred for consideration by itself. But the matter 
of suckling may be here spoken of. 

During the first month of the child's life it should be 
suckled every two hours, counting from the beginning of one 
nursing to the beginning of the next. During the second 
and third months the interval should be two and one half 
hours, and after three months have been reached three hours. 
Nothing is gained by more frequent suckling, and a good 
many harmful consequences may result. It is not meant 
that every, child requires just the same amount of food or 
frequency of meals. But in every case regularity is of the 
first importance. Further, if an infant in ordinarily good 
condition is not content and properly nourished when nursed 
as above, there is reason to suspect that the food itself is 
deficient either in quantity or quality. More frequent put- 
ting of the child to the breast is not likely to increase the 
one or improve the other. 

The evidences of suitable and abundant breast milk are a 
fairly prompt completion of the nursing, followed directly 
by a good sleep lasting nearly or quite until the next nursing 
time, a contented condition when awake, regularity of the 
bowels, and a satisfactory and progressive gain in weight. 
The contrary of these— namely, prolonged sucking without 
evident satisfaction, broken or short sleep, fretfulness, bowel 
disorders of various sorts, and insufficient gain and, in the 
later months of the ordinary period of suckling, a delay of 
the usual signs of development (see chapter on *' Growth and 



NURSERY ROUTINE 35 

Development") — are to be counted as probable evidence of 
defective quality or quantity of the breast milk. Whenever 
such symptoms occur, the question of artificial feeding, 
wholly or supplementary to the breast, arises. 



CRYING 

A w^ORD here is proper regarding crying. While the un- 
derfed child does cry, is usually fretful and peevish, it does 
not follow that every cry is a call for food. Many times 
the little creature, who has ''no language but a cry," is 
thirsty, and a teaspoonful of water will be the best satis- 
faction. Very often, indeed, the cry is the expression of 
overfeeding and internal discomfort, although this is far 
less frequent with suckled than with bottle-fed infants. In 
the latter, also, wakefulness or restlessness is frequently an 
evidence of overfeeding. 

The observant mother may soon learn quite a little from 
the baby's cry. She will distinguish the ''worrying" cry 
of discomfort, sleepiness, or fatigue, the loud outcry with 
squirming or drawing of the lower limbs, which is indicative 
of abdominal pain of some sort— colic, perhaps, or discom- 
fort in the urinary passages. Later, also, the explosive cry 
of fright or anger. The various sick cries may be distin- 
guished, but are often deceptive. Thus, crying after cough- 
ing is usually interpreted as meaning thoracic sensitiveness, 
while the child with pneumonia generally saves his breath 
and can rarely spare it for outcries. But there are excep- 
tions. The hoarse cry of croup can only be referred to the 
right place— the larynx. 

UNSUCCESSFUL SUCKLING 

Returning to the matter of suckling, the following is to be 
noted : If there be a doubt about the need of supplementary 
food, the painstaking physician will be the best adviser. He 
will often easily point out errors in the maternal hygiene or 



36 THE CENTURY BOOK FOR MOTHERS 

in the infant's regimen which have, not unnaturally, escaped 
the mother's notice. One of the commonest errors noted in 
the stress of modern life is this : The function of suckling is 
a natural one, and as such is not exhausting. But in order 
that any natural function be properly performed, the life 
must be a natural one. Whenever the so-called ''social 
duties" take precedence, in fact or in desire, of the maternal 
ones the nutrition of the infant is threatened. It is true 
that many children are unwelcome guests, and the usual re- 
straints Avhich pregnancy puts upon social activity are un- 
graciously borne. In such cases, though the further re- 
straints entailed by suckling are very likely resented, the 
nursing, if performed at all, is done under such conditions 
as to make it of doubtful value. But we often see w^omen 
who have gladly become mothers, and who desire to do 
their duty to their children, undertake suckling under cir- 
cumstances sure to entail failure. How often do we see a 
mother successfully suckle the little one until she begins to 
take up her former social life. AVhen the baby's afternoon 
nursing is hurried, in order that the mother may pour tea 
at Mrs. Blank's, which she does under a worrying conscious- 
ness that the baby's next meal will be overdue before she 
gets home, the nursing-bottle and its accompaniments are not 
far off. 

But the most devoted mother, in otherwise good health, 
may be defeated in her attempts to suckle her babe by some 
apparently slight matter. One of the commonest is tender, 
irritated, or cracked nipples. Sometimes the pain of each 
nursing is such as to draw tears to the mother's eyes or to 
make her faint, and the frequent repetition of the suffering 
may so exhaust her that the breast milk is no longer suffi- 
cient. In the chapter on ' ' The Preparation for Motherhood ' * 
some suggestions regarding the care of the nipple were made, 
and the same are still of value after delivery. 

After each suckling the nipple should be washed with 
warm water, and afterward with a boric-acid solution if 
there is any irritation. Then it should be most carefully 
dried. These precautions are preventive, and to be used 



NURSERY ROUTINE 37 

even in a perfectly healthy state of the nipples. As the 
nipple and the baby's mouth are so intimately in contact, 
and affections of one may spread to the other, the latter 
should also be cleansed in the same manner after each suck- 
ling. If the nipples be very tender it is wise to protect them 
at the time of suckling with the well-known nipple shield, 
which is essentially a glass dome covering the nipple and 
the neighboring part of the breast so that the tender parts 
are not irritated by the contact of the baby's mouth, while a 
rubber nipple at the summit permits the sucking to be done. 
For actual cracks of the nipples, various applications are 
made. Of these, some previously mentioned may be em- 
ployed. In severe or obstinate cases it is better to consult 
the physician, who will make more efficient ones. But the 
treatment of a cracked nipple which has been well established 
is tedious and often results in the abandonment of the use 
of that breast. 

THE MOTHER'S DIET 

The diet of the nursing mother should be ample and digest- 
ible. But it should be varied. While it is probably true that 
some kinds of food may affect the taste of the mother 's milk, 
this fact should not be allowed to limit her choice too much. 
On the other hand, she should not fall into the error of over- 
feeding. The amount of proteids in the diet governs largely 
the amount of the same and of fat in the milk, and an unusu- 
ally rich dietary may do harm, as well as an unusually poor 
one. Beside the usual varied table diet, adjusted to the di- 
gestive peculiarities of the individual, milk may be used as 
a ready method of obtaining all those elements which are 
to be reproduced in the mother's milk. It may be taken 
between meals and at bedtime most advantageously, and it 
should be kept in mind that it is a food, not a simple bev- 
erage. The writer has never been able to see that any real 
gain came from the use of beer or alcoholic beverages, except 
occasionally to increase the appetite. Some good observers, 
however, hold a different opinion. 

Among the conditions affecting the composition of the 



38 THE CENTURY BOOK FOR MOTHERS 

mother's milk may be mentioned emotional disturbances and 
menstruation. Emotional women do not make the best 
nurses, and it is a matter of common observation that strong 
emotions, probably anger most of all, are likely to be fol- 
lowed by disturbances in the child. A wilful or unrestrained 
woman should never be employed as a wet-nurse, and it is 
doubtful whether a mother of such temperament is prefer- 
able to bottle-feeding. It would not be even advisable if it 
were certain that such a mother would be any more careful 
of the food than of her temper. 

The effect of menstruation upon the quality of the milk 
is sometimes marked, but experience differs as to the fre- 
quency with which this effect is noticeable. The writer's 
experience is that the effect is generally not great, except 
when the menstruation begins at a time rather late in the 
nursing period, in which case it is rather a signal that the 
activity of the breasts is becoming subordinate than a dis- 
turber of the condition of the child. It is then a hint that 
supplementary feeding is called for. When menstruation 
occurs early in lactation the baby's condition, especially as 
regards the bowels, should be watched. The child probably 
need not be taken from the breast, or if so only for a few 
days. 

BATHING 

The directions as to the bath routine, given on page 27, will 
hold good for a child of average strength until it is about six 
months old, when the temperature may be dropped a few de- 
grees and thereafter a degree or two from time to time, so that 
a child of good physique a year old will probably react well 
from a dip into a bath as low as 90° F. But the blunder 
of ''hardening" by too rapid change should not be com- 
mitted. As children increase in age the bath may be changed 
in character, rather than in temperature— that is to say, a 
young child cannot well bear immersion, at least for more 
than a few seconds, in water much below 90° F. The sur- 
face of a little child's body is very large in proportion to 



NURSERY ROUTINE 39 

its mass if compared with that of an adult. This fact and 
the susceptibility of its nervous system doubtless account for 
the ease with which a child is depressed. On the other hand, 
the stimulating efPect of a slight, cool sponging upon a 
healthy child is undoubted. Hence it has been a standard 
practice to let the child stand ankle-deep in Avarm or tepid 
water while it is quickly sponged over Avith water of, say, 
70° F., or even cooler in some cases. But it should be borne 
in mind that for feeble children or for those not evidently 
feeble who do not react well from any chill or cool bathing 
great care in this direction is to be exercised. When borne 
well, the cold sponging alluded to is especially useful about 
the throat, neck, breast, and shoulders as a safeguard against 
the common tendency to 'Hake cold." 

Although the question of sea bathing is not one that con- 
cerns infancy, it may as well be mentioned in connection 
with bathing in general. Bathing in salt water may begin 
at about three years of age, provided the water be warm and 
quiet. Under no circumstances should a child be taken into 
the water or be romped with there in any way likely to 
alarm it. The beginning may be made on a warm day, the 
child being allowed to play alone in the shallow water or 
being carried in the arms of an adult. This '' paddling," 
however, must be watched, because it is harmless only so long 
as the child is kept warm by activity. Any dawdling with 
the feet in the relatively cool sea-water is not permissible for 
a small child. Gradually, as strength and courage increase, 
the child may venture farther and remain in longer, and 
essays at swimming be made. Real sea bathing— that is, 
bathing in the open ocean or in the surf— is not a child's 
play at all. The shock is very considerable even in quiet 
weather, and only older, adolescent children should be al- 
lowed to indulge in it, except under the careful supervision 
of an adult. The test of suitability in sea bathing, as in any 
cold bathing, is the promptness and completeness of the reac- 
tion. If there is any chilliness remaining after the rub 
clown, the bathing is probably harmful. 



BABY'S AIRING AND EXERCISE 

ANEW infant cannot be said to need exercise in the ordi- 
. nary sense. Its rapid growth and development demand 
the abundance of food it ingests. There is no need for mus- 
cular activity, as would be the case with an adult, or even 
with an older child eating anything like such a proportion of 
its own weight daily. Fresh air, however, is advantageous 
to the infant, provided it can be had without exposure. In 
warm weather the child may be taken out of doors, in places 
sheltered from wind or too strong sun, very early in its life. 
In cold weather this going out must be postponed in pro- 
portion to the lowness of the temperature and the feebleness 
of the child. When first taken out, especially in cool 
weather, the child should be carried in arms. It needs the 
warmth of the attendant's person, the support of her arms, 
and it is safer from jolts than it would be in a baby-carriage. 
In thus carrying a child it should never be forgotten that it 
is taken out for its benefit, not for admiration. Its long 
garments and wraps should be kept closely about it, and the 
habit, less frequently seen than formerly, of supporting the 
infant in such a way that one hand or arm is within its 
wraps, permitting the latter to fall gracefully and display 
its embroidery, need only be recalled to be reprobated. 

THE BABY-CARRIAGE 

AViiEN a child is taken out in its carriage its protection 
should be in accordance with the demands of the tempera- 
ture. If this be low, an abundance of light, warm' wraps, 

40 



BABY'S AIRING AND EXERCISE 41 

mth a foot-warmer of some description within, will be called 
for. The carriage for infants itself requires a hood or 
chaise-top for protection both from sun and Avind. It may 
be doubted if a day so damp or so Avindy as to call for a 
veil is a suitable day for the infant to be abroad. On such 
days probably greater advantage is gained from the placing 
of the carriage, with the child, in a sunny, well-aired, and 
unwarmed room than in taking it out of doors at all. And 
this hint will serve for older children, especially in cities, 
where, if they go out, they must walk near gutters in drafty 
streets. The whole question is not of outdoors or indoors, 
but. Where can the' most sunshine and sweet air be had ? 

The carriage should have easy springs, so that the child is 
not harshly jolted by inequalities of the surface. It should 
have a comfortable mattress, and a pillow suitable to the size 
of the child, supporting its head without bowing the shoul- 
ders. It should have a strap or some contrivance to prevent 
an active infant from throwing itself out of the vehicle or 
being thrown out by any accident. In wheeling a baby- 
carriage attention should be given to its course, as a small 
stone is a serious obstacle to so small a vehicle, and a curb- 
stone becomes a precipice. The eyes of the little one 
should not be exposed to the strong sun while it lies upon 
its back. The hood can be so tilted as to shade the face, 
while the sun- warmed air permeates the whole vehicle. 

EXERCISE FOR OLDER CHILDREN 

As the infant becomes stronger it takes its exercise by kick- 
ing, learning the use of its hands and members, later by sit- 
ting up, then by creeping, learning to stand, to balance, and 
later to walk. Sitting alone probably will come at about 
six months of age; walking alone at from twelve to fifteen 
months. Unless the child is exceptionally dull in mind, do 
not urge it to make advances. As it feels its power it will 
try all these new acquirements and make gains more or less 
rapidly, according to its ability and natural gifts. Like- 



42 THE CENTURY BOOK FOR MOTHERS 

wise, be always gentle in playing with a baby. Hard trot- 
ting, tossing, and other horse-play is undesirable and in- 
judicious. 

Exercise for its own sake is the result of a high artificializ- 
ing of life. Wild animals get enough of exercise in the search 
for food. Man, either in the wild or civilized state, so long 
as his occupation is one of physical exertion, usually gets 
enough, and at most needs some change of occupation or 
exertion when his usual one is too highly specialized as to 
the muscles employed. So with children in any surround- 
ing where the natural admixture of outdoor play and of 
assisting in family cares and duties according to the strength 
of each exists. 

When, however, a child is so situated in life that every- 
thing is done for it except the chewing of its own food ; when 
outdoor life is restricted to a joyless walk with a nurse, and 
much of its time must be spent in the schoolroom, the watch- 
ful parent is obliged to invent or seek out forms of exercise. 
For the country child, walking, climbing, rowing, fishing, 
hunting, and the numberless games of summer-time ; skating 
and coasting and the like in Avinter, are enough. For the 
town child some of these are still available. But as the 
city is transformed into the great city, the distance from 
the home to the place of play or exercise becomes greater 
and greater, and all the available time is given to the going 
and coming. Hence the growing need of parks, not only as 
places of display, but of exercise and recreation; the call 
for gymnasia for the older children, calisthenic classes for 
the younger, where the advantages of the exercise per se are 
much increased by the learning to do things systematically 
and in cooperation. These are especially desirable for the 
feeble child, who lacks the impulse, and for the phlegmatic 
or indolent child who shrinks from exertion. The gymna- 
sium, of course, presupposes a judicious teacher who will 
guide, stimulate, or check as each child needs. If no gymna- 
sium be available, the parent should choose the exercise as 
far as practicable, not from the fads of the moment, but 



BABY'S AIRING AND EXERCISE 43 

with regard to the needs of the child and its strength, age, 
and development, and should see that no amusements be in- 
dulged in which are harmful bodily or mentally, and, as 
adolescence is reached, try to prevent overdoing in competi- 
tive games. It hardly need be said at the present day that 
up to puberty a girl should have the same freedom of exer- 
cise as a boy, and at and after puberty she need be restrained 
only as special occasion occurs, although she should no longer 
put her strength against that of the adolescent boy. 



VI 
DRESS AND CLOTHING 

THE first clothing for a child is, of course, prepared in 
advance of its birth, and might have been considered in 
connection with the preparations for maternity. It seems 
preferable, however, to make it a part of the general treat- 
ment of the subject of dress. 

While dress varies very much in different countries, cer- 
tain peculiarities are so uniform in all as to merit considera- 
tion as general principles, although the applications must 
accord with the demands of climate and external conditions 
of all sorts. These general principles are, first, that the 
protection against cold must be adequate to conserve heat 
within the limits of the person's producing power. In hot 
climates, of course, this conservation is hardly called for, and 
protection from the sun and the demands of decency are the 
essential factors. Second, that the protection shall be as 
nearly uniform over the person as practicable, some extra 
safeguarding being generally given to the cavities of the 
trunk. Lastly, that the clothiiig shall be as unrestraining as 
to the motions and the functions of the body and as little 
burdensome as possible. Still further may be added the 
subordinate qualifications of unirritating surface and es- 
thetic appearance. 

These requirements have been put in the order of impor- 
tance as they apply to infants' clothing. It is to be re- 
gretted that the order is often reversed in practice. The 
requirements of protection and want of burdensomeness are 
best met by garments of soft, porous texture, as such are 

44 



DRESS AND CLOTHING 45 

poorer conductors of heat than others and best conserve the 
body warmth, while they are permeable to the body's exhala- 
tions. The universal experience, Avhere choice exists, is that 
garments of wool have the desired combination of these quali- 
ties in the highest degree. If there is no unusual sensitive- 
ness of the infant's skin, that garment, at least, which is 
next the skin should be of a soft woolen fabric of such tex- 
ture that it is freely elastic and unirritating to the skin. 
Machine- or hand-knitted fabrics perhaps most perfectly ful- 
fil the requirement. For sensitive skins or in those climates 
where woolen garments are unsuitable, soft cotton fabrics, 
or knitted silks if the purse permits, must be used instead. 
It may be well to know that the element of non-conducting 
power may be gained, even in fabrics not otherwise the best, 
by increasing the number of layers. Thus two or three thin 
undershirts, one over the other, are often better protection 
than one shirt as heavy as their united weight and of the 
same weave. 

The greatest objection to fabrics of all wool is the remark- 
able shrinkage which occurs in washing by any but the most 
expert hands. Properly washed, they may last a long time ; 
but the writer has frequently seen loose, all-wool outing 
shirts shrunken by a laundry beyond the possibility of wear- 
ing in three washings. This has led to a great variety of 
devices, the ordinary one being to mix enough cotton with 
the wool so that it will not shrink inordinately, while pre- 
serving a large part of its warmth. Such goods are gener- 
ally called merino, the proportion of cotton varying greatly. 
Another combination was that in which a wool face or pile 
was incorporated with a cotton-web backing, the former giv- 
ing warmth, while the latter resisted the shrinkage. 



THE PRINCIPAL REQUIREMENTS IN DRESS 

All infant garments should be very free and loose-fitting, 
no constricting bands or parts being permitted anywhere. 
In detail, the garments are usually the following : 



46 THE CENTUEY BOOK FOR MOTHERS 

First a girdle, called the binder or band, the first use of 
which is to retain the dressings of the cord and to protect 
the unhealed umbilicus from injury. After the healing of 
the navel it is of doubtful benefit, since its name seems to 
suggest to the nurse or mother that it ought to bind, or be 
tight, which it should never do. There Avas a notion, which 
may still survive, that a tight bandage would prevent rup- 
ture. This was a blunder. It did not prevent abdominal 
or navel hernia, and by increasing the strain lower down it 
favored groin hernia. If, however, it be remembered that 
the band is simply for warmth and not for support, and 
that it should be loose, it may be advantageous. Unless it be 
made with shoulder-straps or some appliance to keep it in 
place, it is likely to slide about unless too tightly pinned. 
The writer, therefore, prefers a shirt. If the band be used, 
it should be of flannel or knitted, and should reach from the 
breast to the napkin. But the shirt has all its advantages, 
and is not likely to be too tight. In fact, many so-called 
binders, with shoulder-straps and a pinning-tab for fasten- 
ing to the napkins, are really only sleeveless shirts. 

THE NAPKINS 

The other garment going next to the skin is the napkin. 
It is rather a misnomer to call it a garment, as, Avhile it is a 
covering and a protection, it would probably never be used 
save to protect the other garments from being soiled by the 
urine and evacuations from the bowels. But its contact 
with the skin requires that it be treated as a garment. The 
best material for napkins, or at least for inner napkins, 
is old linen of heavy weight, old table-linen cut up being the 
most desirable. But as the supply of this, unless one can 
buy it from a hotel, is very inadequate, most of the supply 
must be bought ; and at the present time we think the mate- 
rial known as cotton bird's-ej^e is generally preferred, most 
new linen being too stifiP for the purpose. It may, how- 
ever, be used at first for outer napkins, and as these soften 



DRESS AND CLOTHING 47 

by repeated washings they may be used as inner napkins. 
Cheese-cloth of rather close weave may be used, and is 
sometimes cheaper than the washing of other fabrics, the 
cheese-cloth being used but once. This material is espe- 
cially applicable for the inner napkins. The napkins must 
be so large that a diagonal of the square will reach around 
the infant's hips and pin easily. They are sometimes 
made square, sometimes twice as long as wide, and are 
folded once to make a square. When applied the square is 
folded diagonally, which Avill make four thicknesses. The 
diagonal edge is put about the infant's waist, and the other 
angle of the triangle is brought up betAveen the thighs to 
meet the other ends. Wlien an inner napkin is used, the 
outer napkin does not really need to be two squares long, 
two thicknesses, when the napkin is folded on the diagonal, 
being bulky enough. Whatever shape is used, the napkin is 
to be hemmed. The size is usually half a yard on a side 
for new babies, and larger as the baby grows. If the double- 
length napkin be used, it is, of course, a yard long at first, 
and later double the increased Avidth is called for. The 
inner napkin is sometimes simply another napkin like the 
first. Preferably it is one of soft material, about two 
feet square, which is folded once each way, making a square 
of four thicknesses about one foot on each side. This is 
laid over the larger triangle, one corner corresponding with 
the lower angle of the outer napkin in such a manner that 
the smaller one will cover the buttocks and genitals. The 
smaller napkin gives all necessary protection against wet- 
ting, and is retained by the larger triangle. 

The care of napkins deserves a word, and really but a 
word, which is that a napkin should be changed as soon as 
it is known to be wet, and should not be used again, how- 
ever little it has been wet, unless it has been rinsed out in 
clean water. Of course, soiled napkins must be thoroughly 
washed. Objection is often made to this simple rule that it 
gives too much trouble ; that napkins merely wet may be 
simply dried, and used again without harm. The answer is 



48 THE CENTURY BOOK FOR MOTHERS 

that there is no easy road to success in child-rearing any 
more than in anything else. If a mother is so burdened 
with cares and duties that the rule cannot be complied Avith, 
she must keep the rule in mind and do her best. As to the 
using again of unwashed napkins and their doing no harm, 
it may be admitted that some skins do not seem to be irri- 
tated immediately by the practice ; but this is not proof that 
it is harmless, and in any case such a procedure is contrary 
to all notions of propriety. 

One thing should be mentioned only for condemnation— 
the india-rubber diaper, or one of any water-proof material. 
It is hard to imagine how any one could have devised the 
plan of poulticing an infant's skin with its own fermenting 
excretions. They are always foul-smelling things, and some- 
times produce grave excoriations or ulceration of the skin. 
If any emergency, like traveling, demands unusual protec- 
tion from moisture, it should be met by an unusual amount 
of absorbent material, such as extra napkins or absorbent 
cotton, which may be thrown away, rather than any imper- 
vious covering to confine the urine about the child. 

The consideration of napkins calls for mention of their 
discontinuance. Of course, infants must be protected until 
they can be taught to give notice of their wants or to relieve 
themselves with sufficient regularity to prevent the danger 
of untimely wettings or soilings. Just at what age this can 
be done cannot be said, as it varies. Disregarding cases in 
which the child has abnormal inability to control the flow of 
urine, as in many cases of bed-wetting, it is probable that 
most children wear napkins longer than is really necessary. 
In fact, our English cousins believe that the American child 
is allowed to depend upon them much longer than do their 
babies. They claim, moreover, that while the infant is still 
but a few months old it can, by the regular holding it over 
a small nursery vessel, associate in its mind the presence of 
the vessel with the act of emptying its bladder or its bowels. 
The plan is certainly worth trying in all eases, since if it 
fails nothing is lost, and if successful the child and its atten- 



DRESS AND CLOTHING 49 

dants are relieved from what it is not too much, in many- 
cases at least, to call the bondage of the napkin, as well as 
from the various irritations and annoyances Avhich arise 
from their unduly prolonged use. 

SOCKS 

The one article of apparel which the new baby is sure to 
find itself abundantly provided with in advance is socks, 
generally in great variety of color, pattern, and material. 
They are unobjectionable if big enough, but are really of 
little use, if indeed of any, while the long clothes are worn, 
and are not comparable for protection to warm stockings 
after the clothes are shortened. While long clothes are worn 
it is just as well to let the infant have the unrestrained free- 
dom of its feet and its fascinating pink toes. 

This is in no wise to be construed as indorsing the expo- 
sure of the feet or limbs. If the ''hardening" is ever men- 
tioned it should be for condemnation. The feet are to be 
always kept warm, but the free wrapping of the flannel petti- 
coat or the more complete protection of the stocking seems 
better. Whether or not the feet need covering during toilet 
depends upon the warmth of the apartment. In a general 
way we should say that an infant should never be washed 
or dressed or changed in a room at so low a temperature as 
could make the feet cold. But if th^ climate or the construc- 
tion of the house is such that it becomes cold at night, a pair 
of extra wide and loose stockings which can be slipped on 
the baby with ease, much as the mother puts on her ''bed- 
room slippers," will be found convenient when the necessary 
changings must be done. 

These three articles— the band or shirt, the napkin, and 
the stocking, if used— constitute the immediate body rai- 
ment. Outside of this a variety of apparel within rather 
narrow limits may be used. The principle of uniform pro- 
tection and freedom of motion should apply to whatever is 
selected. 



50 THE CENTURY BOOK FOR MOTHERS 



OLD-FASHIONED CLOTHING 

The traditional baby clothes, with the ''pinning blanket" 
or ''barry coat," its petticoats with waists, and its dress, 
last of all, had really only this to recommend them from a 
hygienic point of view : they protected the infant from cold. 
Tradition only kept and still keeps them in use. The waists 
had to be made to fold over, as they could not be made to 
fit a chest at first of unknown and then of constantly chang- 
ing dimensions. They had to be pinned or sewed to be kept 
in place, and the result was a tight binder about the thorax, 
which is at least as objectionable as one about the abdomen. 
Besides the harm of this compression of the ribs, the inelastic 
waists are uncomfortable, and the putting on of the suit, 
with its constant rolling of the infant from breast to back, 
reminds a masculine bystander of nothing so much as the 
stropping of a razor. And at the end of the performance 
the infant's patience is usually quite exhausted, and it 
shows it. 

THE "GERTRUDE" SUIT 

Fortunately, better styles of dressing can be had. 

Starting with the shirt or loose binder and the napkin, 
which make the indispensable body protection, and the stock- 
ings (if used) , one good warm layer, such as is gotten from a 
flannel garment reaching from neck to eight or ten inches 
below the infant's feet— a slip, in other words— would con- 
stitute in most climates all the protection, beyond shawls and 
cradle wraps, that the physical needs of the child demand. 
But it is convenient to have further protections, so that, as 
it gains power of movement, it may not displace its covering 
and may still be warm enough. It is also convenient to have 
an easily changed covering to keep the warm garment clean ; 
and, above all, the mother's taste demands something which 
shall make the infant an attractive object, if not a thing of 
beauty, to others as well as to herself. 

One of the first suits to attract attention, which was made 



DRESS AND CLOTHING 51 

in accordance with hygienic needs, was the ''Gertrude" suit, 
devised by Dr. L. C. Grosvenor, of Chicago, and named after 
his infant daughter, for whose comfort it was originally 
devised. Its convenience was so manifest that the demands 
for patterns obliged Dr. Grosvenor to make them public. 
In 1886 his articles were republished in "Babyhood," and 
the suit recommended as the best then within the knowledge 
of the present Avriter. As there described the suit con- 
sisted of ' 

1. The Dress, which, being external, could be of any pat- 
tern to suit the taste, but the recommended one was a plain 
slip. 

2. The Undershirt and Nightgoivn.— These were alike. 
"The best material," wrote Dr. Grosvenor, "is Canton flan- 
nel of medium weight. The hem of the neck, wrist, and 
bottom is turned over on the outside and catstitched, so that 
there shall be nothing rough on the inside. Hems are con- 
cealed by a simple trimming. The nightgown and diaper 
are all that are needed for night wear. ' ' 

3. The Flannel Shirt.— "Made of woolen flannel, with- 
out sleeves, the armholes and neck being scalloped, but not 
bound. May be as ornamental about the bottom as desired. ' ' 

4. The Diapers.— " Cotton flannel is recommended, as being 
softer, warmer, and more absorbent than linen or any other 
material. The hem is turned over on the right side and run 
through the machine. Use the fleecy side next to the baby. ' ' 

Concerning the suit in general. Dr. Grosvenor wrote: "The 
undergarment should be made of nice, fleecy goods— Can- 
ton flannel is the best we have at present— cut princess, 
reaching from the neck to ten inches (twenty-five inches 
long) below the feet, with sleeves to the wrists, and hav- 
ing all the seams smooth and the hems at neck, wrist, and 
bottom upon the outside — the latter turned over once and 
felled or catstitched with colored worsted— a tie and a but- 
ton behind. Here you have a complete, fleece-lined gar- 
ment, comfortable and healthy, and one that can be washed 



52 THE CENTURY BOOK FOR MOTHERS 

without shrinking. The next garment is made of baby- 
flannel (woolen), also cut princess, same pattern, only one- 
half inch larger, reaching from the neck to twelve or four- 
teen inches below the feet — to cover the other — with gen- 
erous armholes pinked or scalloped, but not bound, with 
two buttons behind at the neck, and may be embroidered at 
pleasure. The dress cut princess to match the other gar- 
ments is preferable. 

''The ordinary baby dresses are all right, except that I 
Avould have them only from thirty inches to a yard in length. 

"Now, these three garments are together before dressing- 
sleeve within sleeve— and then are put over the little one's 
head at once and buttoned behind, and the baby is dressed, 
there being but one pin — a diaper-pin — in baby's dress in- 
stead of fifteen. 

'"At night the dress should be simply a Canton flannel 
night-dress and a diaper— the dress being not unlike the 
undergarment in the suit, only a little longer. It is absurd 
to think that a child can rest sweetly in a diaper, a bandage, 
a pinning blanket, a shirt, and a double-gown, as many a 
child is expected to do. ' ' 

The claims made for this method of dressing were : perfect 
freedom to all thoracic, abdominal, and pelvic organs; the 
clothing hung from the shoulders ; the greatest saving of the 
time and strength of the mother in caring for the babe; 
resulting health and comfort to the child; the evenness of 
the covering of the body, there being the same covering over 
the shoulders as elsewhere. 

As a whole, the suit was very satisfactory, its greatest 
merits being its freedom and the facility with Avhich it could 
be put on, giving very little inconvenience to the child. Two 
general objections, however, were soon made to the suit. 
The first was that the inner garment did not cling closely 
enough to the body for many active children, there being 
no binder to protect the abdomen. The second was that a 
better material than Canton flannel could be found for the 



DRESS AND CLOTHING 53 

inner garment, since the downy cotton does not long remain 
downy unless it be washed by very skilful hands. Both of 
these objections seem well founded, and in an ordinarily cool 
climate we prefer that the inner slip be replaced by a knitted 
shirt wdth sleeves, long enough to reach the diaper, to which 
it may be pinned. The inner slip, therefore, will be done 
awaj^ with, and the wool flannel middle garment comes next 
to the shirt. In this way both objections are met by one 
change. 

Various other materials have been substituted. The best, 
aside from the traditional ''baby-flannel," are Aveb-knitted 
stuffs, which are very elastic and pliable. These were used 
in various suits made after the Gertrude pattern. These 
have been found very convenient and acceptable, and the 
inner garment may be easily made snug-fitting without being 
tight, if it is preferred to continue the original Gertrude 
pattern rather than to change to a shirt. 

NIGHT DRESS 

Whatever style of dress is adopted, the night attire con- 
sists, besides the diaper, of one w^oolen garment, the shirt 
or its equivalent in the Gertrude suit. A muslin nightgown 
is often put over this, but if the inner garment of woolen 
be long, no other is needed. 

Various devices are used to keep the feet of the infant, 
after it becomes active, covered by the nightgown. The 
draw-string is convenient for the mother and secure, but it 
is rather restrictive of the motions of the child's feet. But- 
tons and buttonholes across the entire bottom give greater 
freedom. Good safety-pins also do very well. If the night- 
gown be kept down, no stockings are needed in bed. In 
fact, if the bed-covers are warm and secure, without being 
tight, no particular care need be paid to the lower extremi- 
ties while the infant is in bed. The bed-clothing is best 
secured by tapes or safety-pins, extra large siies of the latter 
being made for this purpose. 



54 



THE CENTURY BOOK FOR MOTHERS 



SHOES 






mm^ 




So long as long clothes are worn no shoes are called for; 
the child is usually better without them. When the child 
begins to get its feet out— when it is short-coated, in 
other words— shoes of some sort are 
desirable, especially as the child gets 
upon the floor. The procuring of 
good shoes— that is to say, properly 
shaped ones — for a young child is not 
easy. The ignorance or indifference 
of manufacturers regarding the shape 
of an infant's foot is remarkable. 
Perhaps it is less so now than a few 
years ago, when the writer, looking for 
shoes of the shape of a baby's foot, 
was confidently assured by the shop- 
man that ''there is no shape to a 
baby's foot," probably meaning none 
that he could not distort. The ac- 
companying cut is an imprint from 
the foot of a new-born infant. The 
peculiarity which strikes one is its 
breadth and the inward turning of 
the inner side. It will be immedi- 
ately noticed that the axis of the foot 
is not drawn down the middle of the 
foot, but from the center of the heel 
through the center of the ball of the 
great toe and the center of the end of 
that toe. This is not arbitrary, but 
the line is that upon which an undistorted foot runs in its 
tire-like movement in walking. It is immediately under the 
strongest part of the arch of the foot. In natural walking 
these axis lines of the two feet are nearly parallel. If, now, 
the toe be turned outward— that is, from the center line of 
the body— ever so little, the axis of the toe is no longer con- 






The dotted line shows 
the inner border of the 
foot, which does not touch 
the floor in standing. 



DRESS AND CLOTHINa 55 

tinuous with that of the foot, and the motion begins to lose in 
smoothness and grace. If it be much turned out, as in feet 
long used to pointed shoes, the gait is, to the trained eye at 
least, little better than a limp, and is almost the same as 
after the loss of the great toe. The foot is distorted easily 
in proportion to the youth of the person, and misfitting 
shoes in infancy and childhood usually produce deformities 
not entirely remediable in after years even by the greatest 
care. It must be noted also that stockings are nearly or 
quite as destructive of shapeliness of the feet as shoes, and 
the writer has watched the distortion of feet of adults, care- 
fully looked after in previous years, by the pointed-toed 
hosiery sold in shops of late years, although the patient had 
all the time been most careful as to the shape of his or her 
shoes. 

FASHION IN DRESS 

As the child grows older the dress changes somewhat, but 
for several years the change is not very radical. After nap- 
kins are laid aside, drawers take their place. Young chil- 
dren of both sexes are dressed much alike, and we venture 
to express disapproval of the tendency of fashion in recent 
years to put little boys of two or three years into awkward 
breeches, trousers, or even stiff leather leggings reaching 
nearly to the hips, the child's convenience and freedom of 
motion being sacrificed to the parents' notion of ''style." 
If it be desired for any reason to discard skirts, the knitted 
materials, which are very elastic, or garments of the same, 
machine-knitted, can be obtained with little difficulty in most 
places. 

Fashion and convenience of purchasing probably will al- 
ways govern the details of children's clothing. But what- 
ever these may be, the principles already mentioned should 
be kept in mind— namely, adequate protection without bur- 
densomeness, uniformity of protection, absence of all re- 
straint of motion, especially such as is caused by girdling or 
binding. These should be kept in mind not only in child- 



56 THE CENTUEY BOOK FOR MOTHERS 

hood, but through adolescence. To no one is this freedom 
more necessary than to developing girls ; neglect of it may 
entail mischief of long duration. Further, it must be added 
that the garments, while free, must be of comfortable fit. A 
garment, for instance, which is badly cut in the neck or 
slips about upon the shoulders may annoy the wearer as much 
as, even if less harmful than, too tight a one, and these dis- 
comforts may, in a child disposed thereto, excite muscular 
twitchings or similar disarrangements. Similar discomforts 
arise from unnecessary multiplication of garments, espe- 
cially if numerous bands, belts, or folds are involved. This 
objection bars out many contrivances, seemingly useful, such 
as diaper supporters, various subdivisions of undergarments, 
etc., in which more pins are required, while the covering is 
less uniform. 



STOCKING SUPPORTERS AND DRAWERS 

The rule which forbids girdling or confining of any part 
will exclude the use of tight garters. On the whole, the 
stocking supporter which connects with the waist, or what- 
ever equivalent garment be worn, has fewer objections than 
the circular garter, and it is therefore to be preferred. 

The night apparel of infants has been mentioned. Until 
after napkins are abandoned it requires little change. Of 
the various methods of keeping the bottom of the night- 
gown in place, buttoning is preferable to the draw-string, 
unless the garment be so long that the narrowing by the 
drawing up does not extend high enough to confine the feet 
or bring them in contact with the puckers. For a child two 
years old or upward the one-piece garment known as "night- 
drawers," with or without feet, is generally popular. By 
it the child is completely covered by one thickness in any 
case, however restless it may be. Flannel or Canton flannel 
is the commonly used material, the latter probably the 
more used. It has the advantage of not shrinking much, 
but in other respects is not so desirable as wool flannels. 



DRESS AND CLOTHING 57 

The seams are better turned outward, as they are rather 
clumsy if turned inward. 

GARMENTS FOR OLDER CHILDREN 

When a child begins to creep about the floor some gar- 
ment is desirable, not only to protect its white clothing from 
dirt, but to protect it in some degree from the drafts usually 
prevalent there. Of such there are several patterns. One 
is not unlike a loose pair of the ''bloomers" sometimes used 
by female bicyclists, fastening about the waist as well as 
below the knees. Another, affording more complete protec- 
tion, is like a child's apron having sleeves, but Avith the 
bottom closed except for leg-holes or with short trouser- 
like extensions. Thirdly, little suits of denim overalls are 
often found in the shops where children's garments are sold. 

The extra protection needed or desirable when the child 
goes out of doors will depend upon place and season. In 
the climate of the northern Middle States the child, while 
very young, should in cool weather be taken out only in an 
attendant's arms. An older child goes out in its baby-car- 
riage. Besides its winter clothing it will need a warm cloak, 
a warm hood or close cap covering the ears, a veil if the 
weather be cold or windy, and warm, loose mittens fastened 
by safety-pins or buttons to the sleeves, not tied around the 
wrists. 

Often a foot-warmer of some description is needed, and 
good warm carriage wraps. The exact weight or number 
of these cannot be given, because seasons and places differ 
not only in temperature, but in dampness, which makes a 
day more ''searching" than another equally cold. A feeble 
child also needs special protection. The guarding against 
severe winds, the avoidance of gusty corners, would seem to 
need no mention did we not daily see the child's comfort 
sacrificed to the attendant's social instincts. If the parent 
cannot feel safe in this regard, the child is better off in a 
well-aired cold room, with its outdoor clothes on, than stand- 



58 



THE CENTURY BOOK FOR MOTHERS 



ing by the mouth of an open sewer or beside a foul gutter. 
All of this is in no wise intended as an advocacy of undue 
coddling or burdening of the child with needless garments 
and wraps. It is merely meant to suggest that the child's 
airing should not be a matter of bald routine, but the sub- 
ject of a careful consideration of the facts and conditions in 
the particular case. 



VII 
GROWTH AND DEVELOPMENT 

GROAVTH and development present many aspects, but 
are the same essential process. To the casual observer 
the manifestation of most importance is increase in weight, 
and it is the first to be noticed. All growth and development, 
while continuous, is not strictly uniform in rate, and many 
developmental processes may almost be called paroxysmal, 
because the periods of preparation attract little attention, 
while the outward manifestations are sudden. 

GAIN IN WEIGHT 

Let us begin by considering the increase in weight. At the 
very first the child loses after birth, the loss corresponding 
with those days during which there is no milk secreted for 
its use. But it is probable that the loss is at most only partly 
due to the want of food, since it has occurred in children 
born in hospitals and from the first put to breasts in which 
the milk was established. The main source of loss is doubt- 
less the emptying of the bowels of their accumulated secre- 
tions, as well as the passage of urine, without any food-suppl}^ 
to replace their weight. Doubtless tissue changes may con- 
tribute somewhat. Half a pound or more is lost on the 
average during the first few days, but the amount is made 
good very soon, so that the infant by ten, or at least four- 
teen, days will have reached a weight equal to that at birth. 
If this recuperation has not begun after the first three days 
the milk-supply would better be inquired into, and if it be 



60 THE CENTURY BOOK FOR MOTHERS 

long delayed or is insufficient there is reason for supple- 
mentary feeding or weaning. 

After the increase begins it goes forward— assuming an 
adequate and suitable supply of breast milk — very steadily 
and, at first, rapidly. A net gain of half a pound a week is 
not unusual for a few months, and at least a quarter of a 
pound is to be expected. Later the gain is less rapid, and 
if it be charted into a curve the latter resembles that 
of a body thrown into the air, its initial rise being the 
most rapid. This diminution in the rate of gain corre- 
sponds pretty well with the time of the beginning of the 
process of teething, and it may be that a part of the develop- 
mental energy is diverted into that channel. 

Since the rates of growth are calculated from a mass of 
infants fed upon the breast it may be proper to mention at 
once certain ways in which artificially fed children may be 
expected to vary from these calculations. To begin with, a 
child is not usually put upon artificial food until it is evi- 
dent that its natural supply has failed. In the meantime 
the infant has fallen behindhand, and has something to 
regain beyond the normal. Some more time may be lost in 
adjusting its food to its needs and digestive capabilities, so 
that altogether the little one makes a bad start. But after 
the food is properly adjusted, and the digestive organs have 
developed in ability, the gain usually overtakes the rate 
established for sucklings after some months. This assumes, 
of course, a well adjusted and ample nutriment. We find that 
with artificially fed infants, as seen in dispensary practice, for 
instance, where the feeding has been more or less haphazard, 
developmental processes, such as teething, are retarded, and 
that these children get their teeth on an average some time 
(perhaps a couple of months) later than suckled children. 

Assuming, then, a child upon good breast milk or upon 
a properly arranged food, it is expected that, if of average 
weight at birth, it will have doubled its weight by the time 
it reaches the age of five months, and have trebled its weight 
by the end of its first year. For instance, a child whose 



GROWTH AND DEVELOPMENT 61 

initial weight had been seven pounds might be expected to 
reach fourteen pounds in five months and twenty-one in 
twelve months, gaining about as much in the first five months 
as in the next seven. But it is to be remembered that this is 
an average and applied to average children. It may be that 
a child under weight at birth may reach the average by five 
or six months, and very likely will do so at the end of the 
year, Avhile one who expects a ten-pound baby to weigh 
twenty and thirty pounds at these periods is likely to be 
greatly disappointed. It will be at once noted that the 
seven-pound child, who reached the figures first given, has 
made an average weekly gain of one third of a pound in 
the five months, and of a scant quarter of a pound in the 
next seven. In experience the ten-pound baby rarely shows 
any greater capacity for gaining than the average baby. So 
the tendency is toward the average, and a five-months ' child 
in good condition usually wdll weigh between twelve and six- 
teen pounds, and a yearling eighteen to twenty-five, about 
twenty being a good net weight if a large number of children 
are weighed. 

In weighing children a certain time of day should be 
taken, so that the fullness of the stomach and of the intes- 
tines shall be, as nearly as practicable, the same. 

During the second year the gain is about six pounds. In 
the subsequent years the rate of gain declines somewhat, as 
a rule, so that at seven years the weight, even with ordinary 
indoor clothing (school clothes), is less than fifty (not much, 
however, and in some places not at all), or about forty-five 
pounds net. Then the increase is rather faster, and at eleven 
girls weigh, clothed, seventy pounds, and boys rather more. 
Then the girls gain very rapidly, outstripping the boys, and 
this superiority is maintained for two or three years on the 
average, so that at fourteen both are close to one hundred 
pounds, the girl still in the advance. Thereafter the boy 
passes the girl, and at sixteen he averages from one hundred 
and twenty to one hundred and twenty-five pounds, and she 
about ten pounds less. 



62 THE CENTURY BOOK FOR MOTHERS 

GAIN IN HEIGHT 

CoiNCiDENTALLY With the increase in weight the height, or, 
as it is usually called with reference to an infant, the length, 
is increasing. The birth length, as does birth weight, seems 
to vary somewhat according to races, or at least according 
to countries, and even in different parts of our own country 
differences in the rate of growth of children are noted, which 
may be due more to racial than to topographical causes. 
But American statistics give the average length of new- 
born children, both sexes included, as about twenty and one 
half inches. The gain in the first year is very great, being 
about eight inches. In the second year it is usually less 
than half that, and in subsequent years still less— three or 
two inches— until the great impulse to growth, about the 
twelfth year in girls and the thirteenth in boys, carries 
them rapidly toward their adult stature. Up to this period 
the average weight and height of boys is a little more than 
that of girls, but as the development starts earlier with 
girls, during the twelfth and thirteenth years the latter pass 
the former in both particulars, and their greater weight 
continues even through the fourteenth year. It is to be re- 
membered that these are averages of averages, because in 
one city the girl is found to be the taller only for one year, 
in another for five years, her superiority in this respect 
beginning earlier and continuing later than in other places. 
These variations are interesting to the general reader only as 
a knowledge of them may prevent undue anxiety in case the 
parent finds her child differing much from any table of 
averages she may happen to possess. It should be borne in 
mind that family peculiarities have great influence upon 
individual cases, especially as regards height. 

Under all these circumstances, tables for popular use are 
of doubtful value, since those not in the habit of using them 
are apt to' consider that they have an authority as great as 
tables of interest or of logarithms. We may say in brief 
that the average height of a child of two years, by which 



GROWTH AND DEVELOPMENT 



63 



time it 118113117 begins to be measured standing, is about 
thirty-two and one half inches, to which there is an irregu- 
lar annual addition of between two and three inches until 
the end of the eleventh year, when the start before spoken 
of begins and when the average height is about fifty-four 
inches. By fourteen the girl has reached five feet, and the 
boy is a little past it. After that time the girl grows slowly, 
and the boy outstrips her, the girl at sixteen averaging be- 




Diagram showing proportionate growth of dififerent parts of the body at various ages from i to aa 
ears. Dividing the height at one year into four equal parts, the dotted lines show, for example, 
ow the relative size of the head is diminished in the adult, etc. 



tween one and two inches beyond the five feet, while the boy 
is probably four inches taller and well on his way to the 
completion of his stature, which is practically attained by the 
time he reaches his majority, although it is a fact (as shown 
by the careful measurement of recruits in our Civil War) 
that there is a small but steady increase in height until the 
age of thirty-five. It may also be mentioned that no ade- 
quate explanation has been offered for the enormous growth 
which has been observed of late years in some children, espe- 
cially in adolescent girls. 

The growth of the body is accompanied by a change of 
proportions. Every one is familiar with the relatively large 
size of the head of the infant as compared with that of the 



64 THE CENTURY BOOK FOR MOTHERS 

adult. So, too, the great proportionate length and bulk of 
the trunk, the greater size of the abdomen in early child- 
hood than later. The preceding cut illustrates fairly ac- 
curately the gradually changing proportions of the entire 
body. The open spaces of the skull, the anterior and pos- 
terior fontanelles, gradually close during infancy; the 
smaller, posterior one being completely closed so early, in 
about two months after birth, that mothers and nurses seem 
rarely to recognize its existence. The larger, the anterior, 
one— the "soft spot" of ancient nursery lore— usually re- 
quires about a year and a half for its complete obliteration, 
although this may occur several months earlier or later. 

MUSCULAR DEVELOPMENT 

In early infancy the actual muscular power is greater than 
would be guessed, on account of the want of coordination of 
the movements; an accidental blow from the baby's hand 
or foot reveals a good de^il of force. The evidences of mus- 
cular coordination and control come very gradually. The 
first movements may leave us in doubt as to their inten- 
tional performance. Thus the infant's hand may very early 
close upon the mother's finger or any object placed upon 
its palm, while considerable time will elapse, probably as 
much as three months, before the child grasps anything 
with unmistakable intent. It will likely be quite as long 
before it balances its head of itself when carried in arms. 
Later still, after six and before eight months, as a rule, 
the child gets itself into a sitting posture in its crib, and 
is able to maintain it longer and longer. Soon it draws 
itself up beside chairs or other supports, usually between 
ten and twelve months, but the feat of walking alone is 
not usually accomplished until a month or two or even more 
of the second year have passed. But in walking, more than 
in the preliminary feats, probably because of the rather 
complicated movements of balancing required, a great vari- 
ation in time exists. We have noted a child of eleven months 



GROWTH AND DEVELOPMENT 65 

v/ho walked with perfect freedom, and many, not apparently 
ill, who were equally active only at or near eighteen months. 
It should be especially mentioned that any intercurrent ill- 
ness or disturbing condition of health, sometimes even so 
slight a disarrangement as a necessary change of diet, may 
impair the nice adjustment of function required for walk- 
ing, and, in popular phrase, "put the child off its feet." 
We recall many such instances ; in regard to one the mother 
remarked, "This child has learned to walk three times 



J y 



THE SPECIAL SENSES 

The development of the special senses is quite interesting. 
Probably the general opinion is that infants are born with 
them all pretty well developed, but lack means of showing 
this. Actually it may be doubted if any exist at birth. The 
recognition of light as an annoyance seems to be present as 
soon as the child can be attended to, and the closed eyelids 
exclude it. Little by little it becomes used to the light, then 
seems to enjoy it, very early following a light, if not too 
intense, ^^dth its eyes. But clear vision can come only after 
the muscles of the eye can move harmoniously, and months, 
perhaps half a year, must elapse before the child has sight 
in the sense we usually mean by that word. 

The new-born child is deaf, but its hearing comes after 
certain changes in the ear have taken place. In exceptional 
cases hearing has been definitely noted by the end of two 
months, but very many of the observations on this point are, 
in the writer's opinion, vitiated by the confusion of hearing 
with the recognition of concussion. Infants are notably sen- 
sitive to sudden jars even without sound, and many of the 
alleged instances of hearing seem rather to be cases of rude 
shaking. 

Touch and general sensibility are both far less marked 
at birth than later. This is especially true of touch. Taste, 
at least as regards some substances, seems to be present very 
early. It may possibly exist at birth. It is not easy to 

5 



66 THE CENTURY BOOK FOR MOTHERS 

speak certainly about smell, owing to the confusion at the 
earliest age between manifestations of taste and of smell. 
But one who has watched the action of a young infant in 
being put to the breast can scarcely doubt that the sense of 
smell is stimulating its incoordinate struggle to reach the 
nipple. 

SPEECH 

Two other signs of development are eagerly watched for— 
the first word and the first tooth. Speech is remarkably 
variable in the time of its appearance. There can be little 
doubt of the correctness of the common belief that girls 
speak considerably earlier than boys. At whatever time 
speech begins, the labial sounds and the broad vowels are 
pretty certain to come first, and the infantile pa-pa and 
ma-ma have been accepted in very many tongues as the most 
endearing of titles. The child generally has at least so 
much of language within its first year. 

THE TEETH 

Dentition, or the getting of the teeth, occupies quite a 
prominent place in nursery physiology and medicine. For 
some reason the eruption of the second set seems to interest 
parents far less than the first. Probably it is because the 
first teething has been charged with more causation of mis- 
chief—far more, indeed, than it is probably responsible for. 
Before birth both sets already exist in the jaw in a rudi- 
mentary condition, and those of the temporary, or ''milk," 
teeth are at birth well advanced toward their complete con- 
dition. This condition is as follows: The bulk of the tooth 
is made up of the ivory, or dentine, within which is a cavity 
having the same general shape as the tooth. This is called 
the pulp cavity, and contains a soft substance which is full 
of blood-vessels and little nerves, which may become very 
sensitive. The ivory of the roots or fangs of the tooth are 
covered by a bony layer called the cement. The part of the 



I 



GROWTH AND DEVELOPMENT 67 

tooth protruding above the gum is called the crown, and is 
covered with a layer of very hard substance called enamel, 
which is thick on the tops of the teeth, and gradually be- 
comes thinner as the gum is approached. This is the part 
of the tooth we usually see, practically the only one visible 
in health. The whole process of the extrusion of the tooth 
from its place within the gum to its place without is called 
''teething." 

The temporary set consists of twenty teeth, five pairs occur- 
ring in each jaw. They are in order, counting backward from 
the middle of the 
jaw, the central inci- ^^^^^°^' 

SOrs, the lateral inci- Canine. •'' ^-jf->^ '• Canine. 

sors, the canine teeth, rNT^HHliw^-'''" 

and the first and sec- ^^^ /' €^^^^fl^K\ \ Molars. 
ond molars. The in- i_ (^wl^ "' ' '^W^ ) 

cisors are commonly "'ISifc '^^^Pfl"" 

called ' ' front teeth ' ' ; P^^'^^^ y^''^^^^^^ 

the canine, especially ^ 

in the upper jaw, are Temporary Set. 

called the ' ' eye teeth, ' ' 

probably from their situation beneath the eye, and those of 
the lower jaw are often called the ''stomach teeth," presum- 
ably from a supposed greater amount of disturbance at the 
time of their appearance. The figure shows very well the ap- 
pearance of such a set in one jaw. The order of the appear- 
ance of the teeth is not quite the same in the two jaws. Thus, 
the central incisors of the lower jaw appear most commonly 
in the seventh month. After a pause of a month or two 
the four upper incisors follow. After another pause, perhaps 
a little longer, come the lower lateral incisors and the first 
molars. A more decided pause then comes, and somewhere 
between the age of a year and a half and two years come the 
canines. The second molars, the "two-year-old molars," as 
they are sometimes called, usually come in the first half of 
the third year. So that on the average a yearling child will 
have six of its incisors. At eighteen months it will have 



68 THE CENTURY BOOK FOR MOTHERS 

added the other incisors and the first molars, making twelve 
teeth. The next six months add the canines, making six- 
teen in all at two years, and another half year completes 
the set of twenty teeth. But it should be clearly understood 
that in perfectly healthy children a variation as regards 
this time may exist of three months for the earlier teeth 
and of six months for the molars. Some children perfectly 
healthy may be even older than nine months before a tooth 
appears, and the writer has several times seen teeth coming 
easily through at four months, and proportionately early for 
the rest of the set. Unusual delay in teething will always 
raise an inquiry as to the existence of the condition known as 
rickets. But it is also very important to know the family 
peculiarity in this regard, as with perfect health it causes 
remarkable variations. In some families teeth come very 
early, in others very late. Teeth at birth are occasionally 
met with ; cases are reported in which the peculiarity has been 
discovered to have existed for several generations. The pres- 
ent writer has noted supernumerary teeth in three consecu- 
tive generations, and it may have existed still farther back. 
Observations in dispensary practice show that artificially fed 
children are distinctly behind suckled ones in time of teeth- 
ing. Whether this is equally true of carefully and wisely 
fed children we have as yet not sufficient data to determine. 
Certainly much depends upon the time when the artificial 
feeding became necessary, children Avho get a good start 
often keeping up the process normally. 

There is a rest of about four years, when the eruption of 
the permanent set begins, ' ' the six-year-old molars, ' ' as they 
are popularly called, being the first to appear. The name 
gives sufficiently closely the ordinary time of their eruption. 
They come next to the second temporary molars, and seem 
to make a decided variation in the order of the appear- 
ance of the teeth. But the remainder of the permanent teeth 
do appear in a sequence very similar to that of the temporary 
onest Thus, the central incisors generally come at about 
seven years, the lateral ones following quickly. The first 



GROWTH AND DEVELOPMENT 69 

tricuspids come from nine to ten years, the second bicuspids 
coming about a year later. The canines then come, usually 
between twelve and fourteen; the second molars follow 
pretty quickly. It will be noted that the precedence of the 
molars over the canines in the temporary set is imitated by 
the forwardness of the six-year-old molars, and that the 
place occupied in the temporary set by the molars is taken 
by the pointed teeth bearing the new name of bicuspids, 
while the true molars come behind them in position. The 



Bicuspids. ; 



Molars. / 




Permanent Set. 

last molars, four in all, are called wisdom teeth, because 
their eruption is delayed until an age usually considered the 
"age of discretion." They may appear at any time from 
seventeen to twenty-five years, usually about twenty-one. 

A word should be added regarding the care of the teeth. 
From their first appearance they should be kept clean by 
means of a soft cloth and water. Their durability to a great 
degree depends upon this. It is a mistake to suppose that 
because they are temporary the first set may be safely ne- 
glected. It is important that they be kept in as good condi- 
tion as possible until their successors appear, and in case of 
any defect or decay appearing it is well worth while to give 
them the advantage of a dentist's care. 



70 THE CENTURY BOOK FOR MOTHERS 

Care of the teeth should include systematic cleansing of 
the mouth as well. 

TEETHING 

The foregoing account of the teeth has said little of the 
process of their eruption, or "teething." The usual symp- 
toms are these : As the salivary glands are developed rather 
before the appearance of the teeth the flow of saliva, or 
' ' drooling, ' ' which follows is usually considered as an indica- 
tion that teeth are coming. Possibly the irritation of the 
gums may excite movements of the mouth, lips, and tongue 
which exaggerate the flow of saliva, but in the main the two 
occurrences are simply coincident. When the eruption is 
actively in process the gum is swollen above and around the 
coming tooth. It may be hot and tender, and the child may 
be thirsty, fretful, disturbed in sleep, possibly feverish, and 
sometimes remote symptoms, such as bowel disturbances or 
more pronounced nervous symptoms, may appear. With 
the appearance of the tooth through the surface of the gum 
the local symptoms abate, as well as the general ones, so far 
as they have depended upon the irritation of teething. 

But it should be very clearly understood that disturb- 
ances have been attributed to the process of teething im- 
mensely beyond the truth, owing to coincidences being mis- 
taken for results. No one familiar with children's diseases 
at all doubts that very much disorder of health and discom- 
fort occur at the time of teething. Few will deny that some 
of this suffering and illness is caused by the nervous irrita- 
tion of the process. Much of it is, however, very indirectly, 
if at all, dependent upon the teething. Thus the immense 
majority of "teething diarrhoeas" are due to improper feed- 
ing, either alone or through its overtaxing a digestion al- 
ready disturbed by nervous irritation. ]\Iany proofs of this 
could be adduced, but it is only necessary to remind the 
reader that those teeth which are cut while the infant is at 
the breast cause little disturbance. It is the ''eye and stom- 
ach teeth," teeth which come in the middle of the second 



GROWTH AND DEVELOPMENT 71 

year, when the infant is not only Aveaned, but is most likely 
fed with many improper things, which cause the greatest 
trouble. And if this period coincides ^dth hot Aveather, 
when the infant's food is often spoiled, all the necessary 
circumstances have been aggregated to give the '' second 
summer" its popular ill repute. 

It is not of great importance to decide just how much 
disturbance at the time of dentition is actually due to the 
process and how much to other causes. But it is very im- 
portant to remember that teething attended with other than 
local disturbance is pretty certainly not normal teething, 
and, above all, that stomach and bowel troubles are not to 
be neglected as normal, and far less to be encouraged, as is 
not infrequently done, as a beneficial relief to the system. 

The local symptoms can often be relieved by the proper 
use of the gum lancet, and remoter symptoms should be 
properly treated. 

SATISFACTORY GROWTH 

The foregoing remarks upon growth and development Anil 
have practically answered many questions often asked by 
mothers. It will be inferred that evidence of good nutri- 
tion will be found in the fact that a child's growth and 
development are near that degree described as the average. 
Too great variations either in fatness or leanness, too slow 
growth, or rapid growth, with coincident feebleness, are 
reason for inquiry into the adequacy of the child's dietary 
or hygiene. Such inquiries are to be made thoughtfully 
and with proper frequency, instead of, as is too frequent, 
with alternations of anxiety and neglect. 

The thriving child is generally fairly plump, being nei- 
ther skinny nor offensively fat. Its skin is smooth and soft. 
It sleeps and eats, does not cry without evident reason, per- 
forms its functions properly and regularly, and, if it has 
not been taught bad habits, is content to lie quietly in its 
crib when it has been fed and made comfortable. 



72 THE CENTURY BOOK FOR MOTHERS 

As the child advances, its occupations and requirements 
enlarge, but it is still true that it is content if comfortable. 
It adjusts itself to its surroundings very nicely. The 
mother who attends her own child, suckling it if she can, 
bathing it, or at least attending at its bath, will soon ac- 
quire a knowledge of the details that go to make up the 
' ' comfortable baby, ' ' to use a nursery phrase. Her eye will 
quickly notice a departure from this standard. The same 
sort of care carried through childhood will give prompt 
warning of anything amiss. 

It is well also to notice whether the development is going 
on in a symmetrical manner, or at least as symmetrically 
as may be fairly expected from the child's heredity. An 
occasional look at the straightness of the spine or the square- 
ness of the shoulders is worth while, without waiting for 
the dressmaker to point out defects in these regards. Ex- 
amine the feet to see if they are not outgrowing the shoes, 
becoming crumpled in a pointed shoe, or acquiring corns, 
callus, or ingrowing nails. Proper shoes have been already 
described (see p. 54) . Shoes should alw^ays be worn which, as 
far as practicable, conform to the natural shape of the foot. 
When the dictates of fashion meddle with this rule, it is 
well to remember before abandoning it that there is more 
''style" in a free walk than a fashionable hobble. In cold 
weather, especially in the country, watch for chilblains, 
which are more easily prevented than cured. Also notice 
if there is a tendency to cold hands or feet, which is usually 
considered evidence of a poor circulation. 

When the child begins to use its eyes, notice whether it 
gets nearer to or farther from objects which it is examining 
than do other children. If so, it may be near-sighted or 
far-sighted. Glasses may be used quite early in life— that 
is, as soon as the child begins to study or do any near 
work— with advantage in the saving of the capacity of the 
eyes. Notice also if it have enjoyment or discrimination 
of colors. If there be, while the child is still young, rea- 



GROWTH AND DEVELOPMENT 73 

son to believe that it is in any considerable degree color- 
blind, it should have especial help in such discrimination. 

Similarly, notice its hearing, and especially if its speech 
be unusually slow in developing. And even if the latter 
be normal do not condemn a slow child as stupid or inat- 
tentive until it is certain that it hears Avell and that there 
is no obstruction of the nasal passages from adenoid growths 
or otherwise. In addition, it is proper to notice whether or 
not a child breathes, waking or sleeping, through its mouth. 
If so its nasal passages are probably obstructed. 

OUTGROWING DEFECTS 

The question is constantly asked, regarding various defects 
and diseases, "Will the child outgrow it?" The general 
answer is this: If the defect be due to a nutritional or 
hygienic error which can be recognized and corrected, the 
defect will probably be improved or obliterated by such 
correction. Otherwise it is not likely. For instance, sup- 
pose a rapidly growing child shows a tendency to round 
shoulders. Now, if it be found that this is due to near- 
sight or too much desk-work or too low a desk, and proper 
glasses be provided and the proper changes be made re- 
garding the desk and amount of work, the defect is pretty 
certain to disappear. But if precautions be neglected the 
defect will persist, and probably increase. Similarly of 
lateral curvature of the spine at its beginning, of some 
curvature of the legs, or of distortions of the feet in their 
earlier stages. So also club-foot, recognized and treated 
early is quite a tractable disorder; if neglected till late it 
is very obstinate. 

But of diseases in the ordinary sense of the word, as dis- 
tinct from peculiarities of development, it is fair to say 
that they are rarely outgrown. They run their course. 
Their later stages may differ in modes of manifestation from 
the earlier ones. The untrained observer may not connect 



74 THE CENTURY BOOK FOR MOTHERS 

the two. But the physician often sees in an adult annoy- 
ance the remnant of or the sequel to an uncured malady of 
childhood. 

PHIMOSIS 

This may be the proper place to speak of a retarded de- 
velopmental condition called phimosis. At birth the fore- 
skin of male infants is usually somewhat long and narrow. 
For this reason and because of adhesions still remaining 
between the foreskin and the parts it covers, the foreskin 
cannot usually be then pulled back. But it is not many 
months (certainly within two years) before the developmen- 
tal changes, as a rule, render this retraction possible. A 
certain number of cases do not undergo this change. In 
them the condition is not outgrown. In such, or whenever 
there is irritation of the parts, due to the retention within 
the foreskin of matters which should be cleaned out, it is 
well to relieve the condition by the operation of circum- 
cision. It is an operation of little gravity, and, as is well 
known, it is performed as a ritual ceremony on the eighth 
day by those of the Jewish faith. There is no objection 
to its performance under ordinary circumstances. On the 
other hand, it is by no means universally necessary, as some 
''faddists" pretend. 



CONDITIONS OF PROPER DEVELOPMENT 

The fact that a satisfactorily developing child is usually 
comfortable and quiet has been mentioned. It is also well to 
remember that the converse is equally true— that, namely, a 
child which is becoming nervous is not doing well. Not 
that all children will be alike in temperament, any more 
than will their parents. But if a child has by heredity a 
tendency to nervousness it ought all the more to be saved 
from exciting and irritating surroundings. Good hygiene, 
good but not excessive nutrition, and calm environment Avill 
give the best chances of a stable nervous system. A few 



GROWTH AND DEVELOPMENT 75 

details may be given. It is to be remembered that the life 
of a new baby is almost a vegetative one. Food and sleep 
and the little waking time not devoted to necessary toilet 
the child devotes to acquiring the special senses, and very 
gradually learning to use them. The amount of use will 
in effect depend upon the amount of nerve force it has to 
spare. Obviously, anything which may be done to increase 
the child's activity in this respect is to make an increased 
demand upon this nerve force. So for the first few months 
do not attempt to play with it. It is not a toy. For those 
who must have a fixed rule it may be said, do not play 
with a baby for the first three or four months. But the 
essential thing both then and thereafter is to follow the 
child's initiative. The soothing sound of its mother's voice 
comforts and encourages it. So do the gentle touches with 
which it is laid to rest. Every one knows how easily it is 
startled by sudden or loud noises. As it gains the use of 
its senses and looks at or listens to things about it, answer 
its look with a smile or its listening with a quiet word. 
But do not excite it with play for the sake of seeing its 
response, and then wonder why it cries when you cease. 
This rule of sympathetic appreciation of and response to 
the child's attempts to get into touch with its surroundings 
without over-stimulation goes all through the developing 
age. It is less imperative as the nervous system becomes 
more stable, but it^ continues through school life and through 
the growing years. 

This brings up the question of overstudy and of precocity 
and dullness. The writer believes that in health there is 
practically no such thing as overstudy. The mind does 
what it can, and then rests. If a child becomes nervous 
under study or seems less clever than usual, the intelligent 
thing to do is, not to assume that the task is too heavy, 
but to ascertain if the child is well ; if it sleeps enough and 
well enough; if it eats enough, slowly enough, regularly 
enough, and of the right kind of food ; if its physical func- 
tions are properly performed; if its eyes, ears, and throat 



76 THE CENTURY BOOK FOR MOTHERS 

are normal ; and, lastly, if there is any reason why the child 
is doing its work under worry or in hurry. The child may 
be unable to do its arithmetic examples because it has an 
indigestion, or is cutting a molar, or what not. Exhaust the 
physical causes before attacking the school curriculum.* 

If the suggestions about calm of nervous system are kept 
in mind, there need be no worry about precocity. Much is 
heard about the need of keeping books away from preco- 
cious children. Unwholesome or exciting books should 
surely be kept away. But here again it is safe to trust to 
the child's initiative. Any reading or study of wholesome 
books which it does of its own accord will do no harm, pro- 
vided it gets proper outdoor air and exercise. But the child 
is not to be constantly stimulated by the conversation and 
readings of its parents and adult friends. This is the ex- 
planation of the precocity, often unpleasant, of invalid 
children. Debarred from the sports of well children, they 
are in constant contact with and under unceasing stimulus 
from adult friends, who naturally desire to make up to the 
invalid through assiduous attention the wholesome enjoy- 
ments necessarily lost. 

In the management of dull or somewhat backward chil- 
dren the application of the principles takes other focrms. 
It has been shown by careful scientific and vital examina- 
tions of large numbers of school children ^ that forwardness 
and good physical development are found together, that 
poor development of body and mental backwardness are 
associated. If, therefore, a child be backward, its physical 
condition and its hygienic surroundings should be looked 
into, and any errors corrected if possible. The normal 
condition being restored as far as practicable, it is proper to 
inquire then whether any special help and stimulation are 
really desirable. 

1 Quite recently Dr. W. S. Christopher, of Chicago, has examined the 
public school children of his city with such results. 



VIII 
FOOD AND FEEDING 

OF course the basis of all growth and development is 
proper nutrition, and this depends upon proper food 
and feeding— that is to say, the presenting to the child of 
such aliment and in such form as its digestive apparatus is 
capable of appropriating. 

BREAST MILK 

Every one knows— although it sometimes seems to require 
a pitiable amount of argument to convince individuals of 
the truth— that the proper and ideal food of a new-born 
infant is breast milk. It is not claimed that all breast 
milk is just the same, any more than that all infants are the 
same in digestive power and requirements. Nevertheless, 
leaving out a few cases of diseased or imperfect breast milk, 
it may be safely asserted that there is such an adjustment 
between the digestion of an infant and its own mother's 
milk that the latter, if sufficient in amount, does agree with 
the child and, as a rule, sufficiently nourishes it even in cases 
where, from analysis of the milk, we might have doubts 
that it would do so. This is one of the reasons why it is 
not always practicable to substitute one breast for another. 
This fundamental fact of the suitability of breast milk 
as an infant's food is more completely understood when 
the chemist points out that it contains in a wonderfully 
adjusted form all the ingredients which are found in the 
necessary food not only of infants, but of all human beings, 

77 



78 THE CENTURY BOOK FOR MOTHERS 

not to mention other creatures. These ingredients are the 
proteids or nitrogenous elements, the fats, the carbohy- 
drates, and mineral matters. In all milks the proteids are 
represented by the part Avhich forms the curd— that is to 
say, the casein and the other albuminoids intimately asso- 
ciated with it; the fat of milk, when separated, we call but- 
ter; the carbohydrate of milk is milk-sugar, and in solution 
are a number of salts, chiefly those of lime, soda, and pot- 
ash necessary for the economy. 

These ingredients are found in varying proportions in 
the milk of different animals, a fact Avhich must be kept 
clearly in mind when the question of substitute feeding 
comes up. For us the standard proportions are, of course, 
those of breast milk. Taking the average of many analyses 
by various chemists, we arrive at the conclusion that the 
proteids in human milk are between one and one half and 
two per cent, of the weight of the whole; fats, about four 
per cent. ; sugar, about seven per cent. ; and the salts, less 
than one fourth of one per cent. But, as has been already 
said, these proportions are not fixed. The percentage of 
proteids and fat are very variable, from two to six per cent., 
roughly speaking, while that of sugar is much more nearly 
fixed. The great bulk of the milk— seven eighths by weight 
— is water, and in it the nutrient elements are dissolved or 
suspended in a state of fine division, so that they are pre- 
sented to the digestive organs in a form which they may 
readily attack. Thus, of the proteids the lactalbumen is 
really dissolved, Avhile the casein, finely divided, is held in 
suspension, probably through some action of a lime phos- 
phate. The fats are also finely divided, and held in the 
form of an emulsion, while the sugar and most of the salts 
are really dissolved. These few facts are given because 
they all seem to have bearing upon the preparation of foods 
made in imitation of breast milk. 

Each of these ingredients is essential to a proper food. 
There is a constant waste of nitrogenous matter in the tissue 
changes which are characteristic of life. Only by proteids 



FOOD AND FEEDING 79 

can this waste be made good. But if one were to try to 
live on proteids alone, as, for instance, upon egg albumen, 
the heat of fat-prodncing elements would very soon be 
missed, as heat is gained from proteids only by a relatively 
extravagant consumption. The proteids of breast milk are 
very digestible, more so than any other, to the human diges- 
tion, and herein lies, as will be seen later, one of the great- 
est difficulties of artificial feeding of infants. 

The fats, on the other hand, are heat producers, and if 
combined with proteids render a smaller amount of the 
latter necessary to nutrition. There are also a number of 
tissues, bones, and nerves especially, to the nutrition of 
which fats in some way contribute. The animal fats are 
decidedly more digestible than are vegetable fats, and among 
the former the fats entering into butter are particularly 
digestible. A suckling child gets in its breast milk an amount 
of butter gradually increasing from half an ounce to an 
ounce and a half daily, speaking approximately. It is not 
strange, therefore, that chemical analysis shows that quite 
a considerable proportion of this passes away in the evacua- 
tions. In so doing it acts as a laxative, and is not there- 
fore useless. 

The carbohydrates are also heat producers, and they are 
in part changed into fats and as such, together with a part 
of the fats taken into the system, are stored up in the tis- 
sues, especially in the considerable fatty deposits so charac- 
teristic of well-nourished infancy. The carbohydrate of 
milk is milk-sugar, its name showing that it is peculiar to 
this liquid. Yet, other sugars of the same group, for in- 
stance, cane-sugar or malt-sugar, can be substituted success- 
fully for the milk-sugar, with little, if any, of the incon- 
venience which attends the substitution of other proteicls 
or fats for those of milk. It is, however, not safe to carry 
the substitution of carbohydrates very far. Thus, while it 
is perfectly true that the adult digestive organs have the 
power of changing a large amount of starch into sugar, this 
is not true for the infant, in whom the power exists only in 



80 THE CENTURY BOOK FOR MOTHERS 

a slight degree. Hence the digestive disorders so often seen 
in infants when the latter are obliged to take a food con- 
taining starchy matter in any considerable amount. The 
small amount of salts in milk are of direct use in some in- 
stances, as the lime salts needed for the bones, and also 
probably quite as much so, although not so evidently, in facil- 
itating various nutritional processes, to the proper perform- 
ance of which the presence of these salts seems to be 
essential. 

If we assume that a good, suitable breast milk is the best 
food for an infant, it hardly need be said that a substitute 
food should approximate as nearly as possible the constitu- 
tion of breast milk. How shall this be accomplished? The 
oldest substitutes of which we have knowledge were the milks 
of the domestic animals, whole, diluted, or modified in some 
way. To-day scientific attempts to provide accurate sub- 
stitutes have brought us back to the same basis. 

ARTIFICIAL "FEEDING 

But what of the multitudes of proprietary infant foods? 
Little need be said. It would be useless to go into any 
prolonged consideration of such foods as cannot be recom- 
mended. The foods in common use are of several types. 

First, because probably the longest in use, are the cereal 
foods, used with water or with milk. Such are the arrow-root, 
various flour and meal mixtures, more recently the barley 
and oatmeal preparations, and many others. Of course, these 
and the following, if milk enters into the preparation of the 
food, cease to be cereal preparations, but are of mixed types. 

Second, the malted foods which originated with the chem- 
ist Liebig, and by his name they are often called. 

Third, the milk foods. Condensed milks ought here to 
be included, because, although not called infant foods, they 
are largely used as such. They are essentially condensed 
and dried milk, with the fat removed to a great degree to 
permit of the drying. 
• Beside these groups are many foods not easy to classify. 



FOOD AND FEEDING 81 

many of them being compounds in which one or more of 
the foregoing type ingredients are mingled. 

Now, the first group has the serious objection that the 
foods contain a large amount of unconverted starch— that is 
to say, starch which must enter the digestive organs as 
starch, which, as has just been said, the young infant's 
digestion cannot properly deal with. 

The group of Liebig's, or malt, foods usually contain an 
enormous amount of sugars, some of it being cane-sugar, but 
the great bulk either malt-sugar or grape-sugar or both, 
neither of which is harmful in proper amount, but which, 
as they are found in the foods, tend to give the infant excess 
of fat; and since the foods are deficient in fats and the 
proteids are not always of animal origin the strength and 
nutrition of the child are really below normal, while its bulk 
is quite imposing. As a result, the show baby is often 
rather an alarming object to the physician familiar with 
infants in health and sickness. The milk foods usually, if 
not always, have the defect that the fat was in part removed 
from the milk in order that the food could be made or pre- 
served. In so far, if for no other reason, they fail to rep- 
resent milk as a basis for infant food. 

It is not charged that these foods are distinctly unwhole- 
some, or that they will not sustain life. A number of them 
are intended to be prepared with milk, and owe most of 
their value to this addition, which would usually be itself 
a better basis. Further, some of them, in later infancy or 
for older children, may without impropriety become a part 
of a dietary already amplified. But the writer has for 
many years never felt safe to keep a child long upon any 
one of them. For short periods, especially when an overfed 
digestive system needed rest, they have been found useful. 

COW'S MILK 

What, then, is to be the basis of a proper infant's food? 
Practically, we are driven to the milk of some domestic ani- 
mal. In civilized countries that of the goat, the ass, and 

6 



82 THE CENTURY BOOK FOR MOTHERS 

the cow is the only available one, and the last named 
is the only one in this and most countries which can be 
obtained in sufficient quantity and with sufficient certainty 
to make it Avorth considering. But it must be kept in mind 
that cow's milk is not the best food for young infants, but 
that it is the best basis for such a food. Many things have to 
be attended to to obtain this desirable food, and these relate 
to two general objects— the procuring of pure cow's milk 
and the modifying of that milk in such ways as will adapt 
it both to the nutrition of the infant as well as to its diges- 
tive powers. 

What is pure milk? The ordinary answer is milk just as 
it comes from the cow, to which no water and no adultera- 
tions have been added. But this does not meet a physician's 
idea of pure milk, which is of late expressed by the term 
clean milk. 

PURITY OF THE MILK SUPPLY 

The cow is not a tidy animal, even with the freedom of a 
pasture. Under the conditions in which she is usually kept 
in the winter she is dirty enough. Any one familiar with 
her appearance in or about the ordinary country barn pre- 
fers to forget it. Ordinarily the milker is hardly an im- 
provement in this respect. And the froth of the "foam- 
ing pail" is usually well decorated with unmentionable filth 
before the milk is strained. These points need not be dwelt 
upon, for the present object is not to prevent the use of 
milk, but to stimulate the use of good, clean milk. For 
quite a number of years growing attention has been given 
by physicians and others who were enthusiastic in the matter 
to the production of milk for the market which should be 
really pure. As knowledge, scientific and practical, has in- 
creased, improvements in method have become possible, 
until now milk of remarkable purity, as well as of uniform 
high quality, is obtainable in many of the large cities. 
Milk nearly as good ought to be procurable in country places 
and small towns if consumers are made aware of the neces- 



FOOD AND FEEDING 83 

sary requirements for its production and insist upon them. 
Probably the best Avay to put forward those requirements 
^^'ill be to describe briefly and without unnecessary detail 
what actually is done in some of the best clean milk-farms 
in the vicinity of Ne^v York. 

First, the farm itself is chosen for the excellence of its 
pasturage and water-supply, the wholesomeness of its soil, 
and the drainage of the same. The barns are so constructed 
that there shall be ample room, air-space, sunshine, and 
ventilation, without exposure, for every cow. The floors are 
made of some substance which can be kept clean and free 
from the soaking in of filth, cement-like materials perhaps 
having the most advantages. Devices for watering and 
feeding in the cleanliest manner are employed, and others 
for the complete, rapid, and frequent removal to a distance 
of all filth. The air of the stable is always free from foul 
odors. The feed is arranged upon the most approved sched- 
ules, based upon experience and scientific experimentation, 
and kept in other barns away from the stables. 

Before a cow can be admitted to these barns she must 
have passed the quarantine— that is to say, every cow bought 
is brought to a quarantine barn, not onl}^ to await the devel- 
opment of any acute disease she may have become affected 
with, but in most of these farms to be subjected to the tuber- 
culin test. Unless this shows her to be free from tuberculosis 
she is rejected. If she proves to be sound she takes her place 
in the milking-herd. 

Thus far the provisions insure a sound cow brought into 
the best hygienic surroundings, fed and attended in the best 
known manner. Such a cow should furnish sound milk. 
The next problem is how to keep the milk uncontaminated 
on its way from the udder to the consumer. The ordinary 
sources of contamination are from the cow's body, from the 
milker, from unclean vessels or containers at every step. 
The cow, by reason of the great tidiness of these stables, is 
free from obvious filth. In addition, each cow is daily 
groomed, like well-kept horses. Still further, just before 



84 THE CENTURY BOOK FOR MOTHERS 

the milking the abdomen and adjacent parts of the cow are 
brushed, to remove any loose hairs which might fall into the 
milk, and the udders are cleansed by a man who precedes 
the milker. 

The men who are employed about the stables are carefully 
and frequently examined as to their own health, no one 
suffering from chronic or acute ailments being allowed about 
the cattle. Owing to the danger of the conveyance by milk 
of some contagious disorders, notably scarlatina, which usu- 
ally prevails among children, some model dairies have ex- 
cluded all married men from their service for fear that they 
should bring contagion from home to the milk. The milker, 
before beginning his work, puts on a clean white suit of 
overalls and a white cap, carefully cleans his hands and his 
nails. This washing is usually repeated after the milking 
of two cows, in some dairies after each cow. But the dry 
hand only is used in milking. 

All vessels, from milking-pail to bottles, are carefully 
sterilized wdth steam, often under pressure, before using. 
Each milking-pail is protected by a well-fitting cover, in the 
center of which is a circular piece of wire gauze surrounded 
by a high lip of the same metal as the cover, so that the 
milk is drawn into a sieve pan through which it must run 
to enter the pail. It is customary not to permit the very 
first milk to enter the pail, as it is known that the udders 
themselves usually contain bacteria in considerable number. 
Hence the first spurts are thrown away. The milking-pails 
are emptied into sterilized cans, and the latter quickly trans- 
ferred to the milk-room at a distance from the stable. Here 
everything is kept in a state of complete cleanliness, the 
utensils, apparatus, and the room itself being cleansed 
with steam. The milk is strained through absorbent cotton, 
and is rapidly cooled by cooling apparatus, so that in a very 
short time, not more than twenty minutes from the udder, 
the milk is cooled to the desired temperature, which in the 
best dairies is 40° F. Of course, the same scrupulous, sci- 
entific cleanliness is carried out in the bottling and the 



FOOD AND FEEDINO 85 

keeping of the milk until placed in the hands of the con- 
sumer. 

The effect of these ' ' model ' ' dairies has been far-reaching. 
Within a very few years the writer has heard the proposal 
to exercise such care as has been described not only charac- 
terized as Utopian, but greeted with laughter. Now, not 
only do such farms exist in the vicinity of many great cities, 
but many other farms are conducted in a way which shows 
the influence of their example. It is now easy to get milk 
of a degree of cleanliness which a few years ago was, at 
least in most places, unobtainable. 

The purpose of all these precautions is of course to ob- 
tain a milk free from all disease germs, and also with as 
few bacteria as possible. The various undesirable changes 
of milk— its ''spoiling," "souring," or "turning," in com- 
mon parlance— are due to the activity of some of the kinds 
of these organisms. It is not expected that milk will be 
obtained entirely free from bacteria. It is doubtful if such 
can be had, or if the human milk drawn from the mother's 
breast is ever absolutely sterile. In most cases we know that 
it is not. We also know, however, that milk containing few 
bacteria keeps very well, and may in case of need be kept, 
if cold, without cooking or sterilization, many days without 
any harmful change. 

But it is a part of the regime of a clean milk-farm to 
furnish its product only very fresh. The milk ordinarily 
sold in great cities in the morning is a mixture of milk 
of the previous morning and of the night before— that is 
to say, it comes to the consumer twenty-four or thirty-six 
hours old. Under the circumstances, it is wonderfully good. 
But it has always been the aim of the producers of clean milk 
to deliver it within a few hours after it is drawn, and it is 
sold not more than twelve hours old, often less. So much 
of the details of a "clean" dairy has been given in order 
that those who will read this may have some standard by 
which to judge of the state of the source of their own milk- 
supply and the probable condition of the milk itself. It 



86 THE CENTURY BOOK FOR MOTHERS 

is true that when milk is not what we wish it to be, we 
have in Pasteurization and sterilization invaluable re- 
sources, but the object aimed at is a milk-supply sufficiently 
pure to render these aids unnecessary. 

A pure milk-supply being assured, what shall he the in- 
fant's food? 

THE CONSTITUENTS OF MILK 

It cannot be pure cow's milk. This is so generally the 
experience of observers not only now, but during genera- 
tions, that we need not stop to consider the exceptional in- 
stances of infants, usually not the youngest, who have been 
able to digest whole milk and to thrive more or less well. 
The objection to the use of whole milk for young children 
is not the result of scientific theory, nor is it based merely 
upon the experience gained from using milk not perfectly 
fresh, as in cities, but it was recognized equally well long 
ago in country districts when the milk could be had di- 
rectly from the cow. Nevertheless scientific inquiry makes 
evident the reason of the difficulties universally experienced. 
The constituents of human milk have already been given 
as, on an average, approximately: 

Fat .... 4 per cent. Salts . . i to i per cent. 
Sugar ... 7 " Water. . .87+ " 

Proteids . . li '' 

This, of course, sets aside for the moment the variations in 
different specimens. Examined in the same way, good cow's 
milk from a mixed dairy herd averages about as follows: 

Fat 4 per cent. Salts ... J per cent. 

Sugar . . . . 4i " Water ... 87 " 

Proteids . . 4 " 

If there be in the herd a large proportion of Jersey cows, 
the percentage of fat will be appreciably higher; if of Hoi- 



FOOD AND FEEDING 87 

stein cows, it will be lower. Sugar and proteids vary little ; 
fat varies greatly in different specimens of milk, a fact 
perfectly Avell recognized in the phrases "rich milk," 
"creamy milk," "blue milk," in popular use. 

Now, it will be at once noticed that the amount of water is 
about the same in human milk and in cow's milk, that the 
salts are much more abundant in cow's milk, and that of 
the three ingredients, fat, sugar, and proteids, the total is 
very nearly the same, the human milk often comparing more 
favorably than as given in the above tables. But it A\dll 
also be noticed that this amount is divided very differently 
in the two milks. The amount of fat differs little. Of 
sugar human milk contains much more, nearly twice as much, 
while the cow's milk equalizes this deficiency in solids by 
an increased amount of proteids, which is pretty uniformly 
near the average of fully four per cent., w^hile in human 
milk the amount is very variable. AA^e have averaged it at 
one and one half per cent.— not much more than one third 
the amount found in cow's milk. 

There is still further a difference not evident in the tables, 
which is, however, quite important — namely, that the pro- 
teids in the two kinds of milk differ not only in quantity, 
but in kind. It has already been mentioned that the pro- 
teids in breast milk are very digestible. This is not equally 
true of the proteids of cow's milk for the infant's digestion. 
Both kinds of milk have at least two kinds of proteids, one, 
called casein, is coagulable, the other, called lactalbumen, is 
soluble and, while coagulable by heat, makes a very much 
less tough curd than does casein. In cow's milk the casein 
makes the great bulk of the proteids, while in human milk 
the lactalbumen is twice as abundant as the casein. Every 
one familiar with infants will at once recall the soft, light 
curd of regurgitated breast milk, and the heavy, often hard, 
curd of vomited cow's milk. 

Inasmuch as, so far as is known, the milk-sugar in both 
kinds of milk is of the same kind, and the fats essentially 
the same, it will be seen that the difficulty in adjusting cow's 



88 THE CENTURY BOOK FOR MOTHERS 

milk to the needs of a j^oung infant must lie chiefly in the 
management of the proteid ingredient. 

If the relative proportions of the three nutritive ingre- 
dients, fat, sugar, and proteids, in the two kinds of milk be 
kept in mind it will at once be seen that by simple dilution 
of cow's milk with two parts of Avater the proteid percentage 
of the mixture would be not far from that of human milk. 
But the fat percentage, which should be unchanged, will be 
likewise diluted, as will that of sugar, which was far too 
Jow before dilution. Sugar of milk or another sugar can be 
added in the necessary quantity, but whence shall the fat 
value be obtained? This last problem is the stumbling- 
block of the commercial foods, owing to the difficulty of 
preserving the fats. 

MODIFIED MILK 

Long ago the value of cream, or rather ^^ top-milk/' as a 
basis of food for infants Avas recognized, as it gave a larger 
percentage of fat than did the whole milk. To such or a 
similar basis has the scientific search for a food brought us 
back— to a basis, namely, Avhich offers us fat and proteids 
in such proportions than on dilution the relative percentages 
which we desire may be obtained. The great improve- 
ments in infant feeding of recent years in America consist 
not in providing a new kind of food, but in applying meth- 
ods of precision to a kind of food shown by long experience, 
as Avell as by chemical inquiry, to be peculiarly adaptable to 
the needs of infancy. AA^ith the improvements of dairy 
appliances it is possible to separate the cream from the 
milk not only quickly, but in almost any desired degree of 
fat value. The fat value can also be accurately deter- 
mined. With these facilities, the next step was a natural 
one— namely, to recombine the elements of the milk in such 
proportions as shall approximate those of human milk, 
or to make any other similar combination which may be 
desired. 

The credit of the practical working out of the details of 



FOOD AND FEEDING 89 

this problem belongs primarily to Dr. Kotch, of Boston, and 
Mr. G. E. Gordon. Their work has been seconded by that of 
pediatrists all over the country, and during ten years not only 
have great improvements in method been made, but a very 
helpful accumulation of exact experience has been formed, 
so that to-day the matter of infant feeding is upon a 
much safer and probably more stable footing than ever 
before. 

The methods of work in a milk laboratory do not directly 
concern us here. The physician writes his prescription for 
the composition of the food in percentages as he might write 
for a medicine. The laboratory prepares the former with 
the same exactitude as the skilful pharmacist dispenses the 
latter. The points of direct interest are that the milk em- 
ployed is of the best type of '^ clean milk," that every 
manoeuver in the dispensing is performed with care for 
complete scientific cleanliness. The food is delivered to the 
consumer precisely as ordered. 

The comment is often made, rather as an objection, that 
the laboratory can only be availed of by those living in or 
near great cities, and among them only by those able to 
spend a considerable sum for the infant's food. In one 
sense this is true, and in another not. The direct use of 
the laboratory is in effect limited to those described. But 
the wider usefulness of the laboratory is through the sug- 
gestions it has given to the home modifications of milk ; and 
if all milk laboratories were to cease their operations the 
lessons they have taught would enable physicians every- 
where more wisely to arrange the food of infants under 
their care. 

The home modification of milk can be very satisfactorily 
carried out by any intelligent and careful person. The 
principles are quite simple, and may be applied by any 
one ; careful cleanliness will meet all the details. One thing 
must be first insisted upon, as the writer has very fre- 
quently encountered misapprehensions on this point. Milk 



90 THE CENTURY BOOK FOR MOTHERS 

modification does not aim at making an infant food, but 
food for each individual infant. If a milk mixture were 
compounded to contain the same proportions of fat, car- 
bohydrates, and proteids as average breast milk contains, 
it might suit the needs of more infants than any one of 
the many foods already proposed ; but, after all, it would be 
only one other ''food." The aim of milk modification is to 
provide an elastic method of feeding, so that the propor- 
tion of each ingredient may be without difficulty adjusted 
to the nutritional and digestive needs of each child. The 
variable digestive power of different infants has been com- 
mented on, as well as the fact that infants seem to be born 
with digestions adjusted in some way to the milk of their 
own mothers. It would, therefore, scarcely be expected that 
any one mixture would suit every young infant. It is the 
business of the physician to be familiar with the details of 
infant feeding, and, in case of necessary weaning, to esti- 
mate the needs and capacity of the child at that time, and 
give directions how the food shall be prepared to meet them. 
If his judgment leads him to prefer home modification of 
milk, he writes no prescription to be filled, but he probably 
has one in mind, the working details of which he gives to 
the mother or nurse in charge. 

How are these details worked out? It is not strictly 
necessary for the person Avho is to carry them out to know 
this, but it will enable an intelligent mother to second more 
efficiently the physician's plans if she does know. Still 
further, sometimes the guidance of the physician is not 
obtainable, and the mother must work by herself. Differ- 
ent physicians may arrive at a conclusion in different ways, 
but the essential things considered are these : The age of 
the child ; its condition as compared with the average infant 
of that age as regards development, digestive peculiarities, 
aside from definite illness; and, based on these facts, the 
composition of the food likely to suit ; the amount of it to be 
administered at one time, and the number and frequency of 
the feedings. 



FOOD AND FEEDING 



91 



VARYING PROPORTIONS IN FEEDING 

The quantity may be advantageously first considered. This 
has been carefully estimated by a good many accurate ob- 
servers, using somewhat different methods, but arriving at 
results so nearly the same as give them a good deal ot* 
authority. The main factors in forming an opinion are the 
amount which the stomach of the infant will comfortably 
contain at different ages and the frequency with which the 
stomach must be refilled. The table below gives a pretty 



Age. 


Interval in 
hours be- 
tween feed- 
ings in day 
time. 




Number of 
feedings be- 
tween 10 p.m. 
and 7 a.m. 


Quantity in 
ounces at 
each feed- 
ing. 


Total 
amount in 
ounces in 
24 hours. 


From 3d day to 

end of 1st week 


2 


10 


2 


1 toll 


10 to 12 


2d and 3d weeks. . 


2 


10 


2 


H " 2 


15 " 20 


4th and 5th weeks 


2 


9 


1 


2i " 3 


22i " 27 


6th and 7th weeks 


2i 


8 


1 


3 ^' 4 


24 '^ 32 


8th week to 4 
months 


3 


7 


1 


4 increasing to 5 


28 '' 35 


4 months to 8 
months 


3 


6 





5 " ''7 


30 " 42 


8 months to one 
year 


3 to 3i 


5 





7 to 9 


35 '' 45 



good estimate of the amount usually required. In prepar- 
ing it the writer has made use of his own experience, and 
has compared his results with the tables given in several 
of the more recent text-books, some of which are very simi- 
lar and therefore confirm the writer in his estimates. 

It is, of course, to be understood that one child may actu- 
ally need more than another, hence a little variation in quan- 
tity is provided for. If it is necessary to increase, let it— 
in a healthy child— be done by increasing the amount in 
each feeding, not by diminishing the interval between feed- 
ings. The stomach of the child must have its proper rest. 



92 THE CENTURY BOOK FOR MOTHERS 

In some cases it is possible to get on with but one night 
feeding from the first, and if the infant's habits of sleep 
favor this plan it is to be encouraged, but two feedings are 
allowed during the first few weeks as being more commonly 
called for. But the giving the breast or bottle more fre- 
quently, or the continuance of two night feedings for a 
child several months old, is distinctly reprehensible. The 
quantity for the single feeding would better be kept at or 
near the lower figure given for that age, and not raised, 
unless it be quite evident that the amount given is insuffi- 
cient. Some observers hold that heavier children require 
more than lighter ones. It may possibly be so, but to the 
writer it has seemed that thin infants, those born so, have 
at least as eager appetites and make as large demands as 
fat babies. In any case, the advice just given would better 
be borne in mind, as in artificial feeding the tendency to 
give too large a quantity is almost universal. If a child is 
happy and makes satisfactory gains in weight and devel- 
opment, the amount should be increased with circumspec- 
tion. It will be noticed that the increase in volume of 
daily food is more rapid at first than later. But it will 
presently be seen that the composition of the food also pro- 
gressively changes, so that while the amount of liquid is not 
greatly enlarged the amount of solids, especially of proteids, 
contained in the liquid is considerably increased. 

How shall we be guided in planning the change in the 
solid constituents? There is but little change in them in 
breast milk during the course of suckling, and our ideas as 
to the proportions are the result of observation as to the 
mixtures which in practice do best agree with infants de- 
prived of the natural supply. We need enter into no spec- 
ulation as to why the breast milk may be satisfactory with- 
out change in composition for so long a time. For our 
purposes it need only be remembered that the infant, in 
taking artificial food, even if made from cow's milk, is tak- 
ing nutritive elements which are, for it, far less digestible 
than those of its mother's milk. The mixtures advocated 



FOOD AND FEEDING 93 

by the most experienced Avorkers in this line at the present 
time have been largely wrought out by starting with certain 
ones approximating breast milk in chemical proportion, and 
carefully adjusting them experimentally to meet digestive 
difficulties as they arise. In other words, physiology has 
built upon a substructure of chemistry. 

As a matter of fact, therefore, mixtures are first made of 
a lower percentage of proteids and fats than is found in 
mother's milk, and not until the child is three or four 
months old is its food so strong by analysis as the breast 
milk. Such a method seems to give the best results. Thus, 
a child in the first month would not reach a proteid per- 
centage of one per cent. It would begin in the first week 
with perhaps not much above one half of one per cent., and 
go up to three fourths. The fat per cent, would be only 
about two per cent., or one half that of breast or cow's milk, 
which w^e have assumed to be four per cent., and so on. 
Of course, at such an age the monthly nurse would prob- 
ably still be in attendance, and the physician would direct 
the mixture of the food and the mother would be spared the 
trouble. 

Let us suppose, however, that the mother were obliged, 
when the child was two months old, to make a food herself 
which would supplement wholly or partly her failing breast 
milk. The table (page 91) gives about twenty-four ounces, 
or a pint and a half, as the daily amount required for a 
child wholly artificially fed, to be given in meals of about 
four ounces each. This amount (four ounces), then, is to be 
given at the hours when suckling should take place, provided 
the breast cannot afford the meal, and as many times in the 
twenty-four hours as the breast fails. 

BOTTLES, NIPPLES, AND MEASURES 

Before mixing the food the necessary outfit— bottles, nip- 
ples, etc.— must be procured. 

Of bottles, the most convenient are those graduated with 



94 THE CENTURY BOOK FOR MOTHERS 

ounce marks, since they may be filled to the desired mark 
without other measuring. They should be, if procurable, 
straight-sided, with rounded bottoms and wide mouths, as 
these are the easiest to keep clean. 

The rubber nipples should fit immediately upon the wide 
neck of the bottle. No tubes are to be permitted; they are 
only secreters and harborers of dirt. 

The nipples should have as small holes as the child can 
draw the liquid through without fatigue. Dr. Holt sug- 
gests holes ^' large enough for the milk to drop rapidly when 
the bottle is inverted, but not so large that it will run in 
a stream." The writer often finds it most convenient to 
pick out unperforated nipples and perforate them with a 
fine needle until the desired flow is obtained. Plain black 
rubber nipples are the best. Some prefer the conical shape, 
but the slightly bulbous ones seem to give less trouble to 
some children, and as the nipple is turned inside out in 
cleaning there is really no choice as regards cleanliness. 

The bottles and nipples are to be cleansed thoroughly with 
hot water and soap or soda (any good Avashing alkali will 
serve), and then well rinsed in clear water. It is best that 
they be boiled before using. Afterward, immediately after 
each using they should be thoroughly rinsed and cleansed 
by means of hot water, soap or an alkali, and always steril- 
ized by boiling before being filled. It is a good plan to 
keep the bottles between the time of cleaning and sterilizing 
filled with water, as this prevents any overlooked matter from 
drying on the glass, which then might be difficult of re- 
moval. Nipples are also to be rinsed carefully inside and 
out after using, and kept in a cup or bowl of a solution of 
borax or boric acid in water, say a teaspoonful of either 
powder to a half pint of water. For cleansing bottles a bot- 
tle-brush is necessary. 

An accurate measure for milk and water is necessary. 
The druggists' graduate is the most convenient one, but if 
it be not easily procured any glass can be utilized by filling 
it with water measured in a tablespoon— it being remembered 



FOOD AND FEEDING 95 

that a tablespoon holds half an ounce— and this glass of 
known capacity be kept as a measure. For measuring milk- 
sugar the most convenient contrivance is a druggist's pill 
or powder-box, carefully trimmed until it will, when even- 
full, hold just one ounce of milk-sugar. 

THE SEPARATION OF CREAM 

All the required utensils being ready, a quart bottle of 
the best obtainable milk is provided, and is placed in the 
refrigerator while the cream rises, so that the top-milk already 
spoken of may be used. At the end of six hours sufficient 
separation of the cream has usually taken place. If from 
the quart the upper third be carefully taken it is probable 
that, if the milk has been of good quality, the top-milk 
would have a fat percentage of about ten. If the upper 
eight ounces were taken, the fat percentage would be still 
higher, and if only the top six ounces be taken it is pretty 
certain to contain as much as twelve per cent, of fat. With 
all these various fat percentages the proportion of proteids 
and of sugar and salts will vary very little from that of 
the milk itself. The process of raising the cream has given 
us practically only a superfat milk. 

VARIOUS MIXTURES 

If it be desired to give the two-months' baby a mixture 
containing, say, three per cent, of fat, six per cent, of sugar, 
and one per cent, of proteids, which would in fact be about 
what a good physician probably would propose, how is this 
accomplished? The six ounces of top-milk we assumed to 
contain twelve per cent, of fat, four of sugar, four of pro- 
teids. If to it three parts, or eighteen ounces, of water be 
added, the desired twenty-four ounces of mixture is gained,, 
which will contain three per cent, of fat, one per cent, of 
sugar, one per cent, of proteids, and a proportionate dilu- 
tion of the salts. To bring up the sugar value to the six 



96 THE CENTURY BOOK FOR MOTHERS 

per cent, aimed at, the difference, five per cent., must be 
added as milk-sugar, or, in its absence, as white cane-sugar. 
Five per cent, of twenty-four ounces is one and one fifth 
ounces. This amount, therefore, is to be added to the mix- 
ture and dissolved. Two things are yet to be corrected— 
viz., the amount of salts and the acidity; for while breast 
milk is alkaline in reaction, cow 's milk is nearly always acid, 
and as it comes to the consumer practically always so, this 
reaction can be changed by the addition of lime-water, five 
per cent, being usually enough, and at the same time the lime- 
water in a large degree makes good the deficiency of salts 
due to the dilution of the top-milk. 

Similarly, if it were desired to give to a child of seven 
months forty ounces of food, which should contain, fat, 
four per cent., sugar, seven per cent., and proteids, two per 
cent, (that is to say, the equivalent of a pretty rich breast 
milk), it would be most easily made by diluting with an 
equal volume of water twenty ounces of top-milk, which 
should have an eight-per-cent. fat value. Such a milk can 
be approximately procured by taking the upper twelve 
ounces from a quart of milk, and the remaining eight ounces 
necessary from two thirds of a quart set to raise the cream 
in another bottle. Or the whole might be set in one proper, 
well-covered vessel. After dilution, the sugar value would 
be two per cent., and five per cent, of milk-sugar would be 
again necessary; in this case, five per cent, of forty ounces, 
or two ounces. Lime-water is to be added as before. 

These methods have to be varied indefinitely for differ- 
ent ages, different children, different conditions. When- 
ever medical guidance is obtainable, it is safer to follow it. 
When it cannot be had, the mother should remember that 
it is safer to use a dilute food, and give more of it if 
necessary, than to burden the digestion with too heavy a 
mixture. 

In all mixtures the water used should have been boiled, 
unless the food is to be sterilized. 

It is a disputed point whether or not the use of barley- 



FOOD AND FEEDING 97 

water as a diluent instead of simple water renders the 
curds formed in the digestive organs less hard and tough. 
Nevertheless, the belief that the various cereal waters or 
gruels do have this action is quite general, and there is, in 
the writer's judgment, no objection to their use, and pos- 
sibly some advantage therein, if they be used thin enough 
to be diluents only. The objection to thicker gruels is 
the amount of unchanged starch which they may contain, 
which is beyond the digestion of quite young infants. This 
difficulty it is proposed by some to remove by first converting 
the starch by some diastatic substance. 

FEEDING CONVENIENCES 

It may be proper to here mention one or two conveniences 
in the preparation of the food. The first is a dipper con- 
trived by Dr. Chapin for removing the cream or the milk, or 
both, as desired, from the bottle without mixing them. It 
consists of a little tin bucket with an upright handle of stout 
wire. The dipper holds an ounce, and can be thrust into the 
mouth of the bottle to any desired level and withdrawn full 
with very little disturbance of the contents of the latter. By 
its use any desired number of ounces may be removed from 
the bottle. Without such a contrivance the cream must be 
removed \vith a teaspoon, the bottle being slightly and gradu- 
ally tilted to allow the use of the spoon. A better way is 
to use a glass siphon to remove the milk from below until 
only the desired amount of top-milk is left in the bottle. 
Where milk is set to rise in a pan, the latter should be cov- 
ered, a measured quantity only of milk being in it. From 
the top the desired number of ounces can be easily skimmed 
or dipped. 

The other contrivance is a sort of measuring-glass, upon the 
different sides of which are blown marks showing the amounts 
of the various ingredients of modified milk mixtures in com- 
mon use at different ages. If it be kept constantly in mind, 
as has been before insisted upon, that neither these nor any 

7 



98 THE CENTURY BOOK FOR MOTHERS 

other mixtures are fixed, but tentative, the apparatus will be 
found convenient in the mixing of food. The effects of a 
food mixture, however and by whomsoever mixed, are to be 
watched, and its proportions retained or altered according as 
the mixture seems to meet the requirements. 

Whatever the mixture that has been mixed, it is divided 
into the requisite number of sterilized bottles, each con- 
taining the amount of food intended for one meal. If a 
child well along in its first year requires more food than 
one nursing-bottle will hold, the amount for one meal may 
be divided between two bottles. But a bottle once opened 
for use must not be ''warmed over." Thus, if a child re- 
quires twelve ounces at a meal and eight-ounce bottles are 
the largest obtainable, it is better to put six ounces into the 
bottles and to use two than to use one bottle and part of 
another, keeping the other part to eke out the next meal. 

If the food is not to be sterilized, the bottles should at once 
be tightly stopped with absorbent cotton and placed in the 
ice-box. When one is needed it is taken from the ice-box, 
placed in warm water until the food is blood-warm, when the 
stopper is removed and the nipple is placed upon the bottle 
and the food given. It is better to hold the child while it 
takes the bottle, or at least to hold the bottle so that the food 
shall be always at the nipple-end of the former, and the child 
not be sucking upon an air-chamber instead of its food. 

STERILIZATION 

Shall the food be sterilized? Sterilizing in the full sense 
is done by raising the contents of the bottles to the tem- 
perature of boiling water— 212° F. Pasteurizing is the 
name given to sterilizing at a lower temperature— 167° F. 
ordinarily. Food may be sufficiently Pasteurized for safe- 
keeping for a day at still lower temperatures. Various 
sterilizers and Pasteurizers are in common use. 

If the food be promptly made from a milk answering the 
requirements of "clean milk," already discussed, all the 



FOOD AND FEEDING 99 

manipulations being quickly done with every precaution 
and the food kept on ice, it is likely that, under ordinary 
circumstances, sterilization is unnecessary and, if so, unde- 
sirable. But in all cases where any doubt exists as to mate- 
rials, methods, or surroundings, it is far safer to Pasteurize 
or, if necessary, sterilize the food. If one of the well-known 
forms of apparatus be procured, full directions are given 
Avith it. In the absence of an apparatus, any culinary steam- 
ing utensil may be used for sterilization. 

One thing should be mentioned. If food is to be sterilized, 
the lime-water should be added to each bottle after and not 
before the steaming, as in the latter case a change takes place, 
somewhat discoloring the mixture. 

Other admissible foods during the latter part of the first 
year are certain preparations made from cereals and from 
meat. The word admissible is used because it seems to the 
writer that during the first year they are not really called 
for in health. In cases where casein cannot be digested or 
for any other reason milk must be temporarily set aside these 
preparations are useful. In many other cases they seem 
acceptable to the child. Nevertheless, the ordinary occa- 
sion for their use during the first year, so far as the writer's 
experience goes, is that for some reason the mother thinks 
the baby ''ought to have stronger food." Although these 
articles in any form which an infant can digest are not com- 
parable in nutritive value to milk, they do for some reason 
appeal to the imagination as stronger food. 

GRUELS 

The forms of cereals permitted are decoctions, the best 
known being barley-water or oatmeal-water or gruel or, 
formerly more than now, arrowroot gruel. The latter had 
great repute in bowel troubles for young and old, but at 
the present time the barley and oatmeal preparations are 
in general use. Receipts for gruels very acceptable to adult 
invalids are found in most cook-books, but the oatmeal or 

L.ofC. 



100 THE CENTURY BOOK FOR MOTHERS 

barley-water used for mixing with the infant's food must 
be considerably thinner than these preparations if the first 
experiments in the digestion of starch are to be made at the 
age of eight or nine months. The making of barley-water 
from the whole grain is so tedious a process that it is better 
to use some good preparation of barley, in flour-form pre- 
ferred. If none can be readily procured the cleansed grain 
can be ground finely in a coffee-mill, which should of course 
be first freed from all traces of coffee. Of these finely 
ground preparations about three teaspoopfuls should be 
boiled for at least a quarter, better a half, of an hour in 
a pint of water. The liquid is then strained through a 
fine strainer, preferably a cloth. It is used as a diluent 
of milk instead of an equal bulk of water. Oatmeal is sup- 
posed to be more laxative than barley, and is used for gruel 
in cases of constipation. The various previously cooked 
preparations of oatmeal on the market render the making 
of the gruel easier than it formerly was. Time is gained 
if even these are ground as recommended for barley. In 
cases of emergency a gruel can be made from oatmeal por- 
ridge by boiling a tablespoonful of it in a pint of water 
and straining as before. 

Gradually the strength of these gruels is increased by the 
use of a larger amount of the cereal to a given amount of jJt 
water. 

BROTHS AND MEAT JUICE 

The meat preparations admissible are broths, beef-tea, and 
beef-juice. They differ in food value, as well as in the 
uses they are best adapted to. Thus, in beef -juice or in 
beef-tea a larger percentage of proteids will be found than 
in broth, but inasmuch as in making broth or beef-tea the 
amount of liquid obtained is much larger than from squeezed 
beef, the total amount of proteids obtained from a given piece 
of meat would be best if the beef-juice method be employed. 
There are, however, in all meat preparations, such as those 
mentioned, a group of substances called extractives, to many 



FOOD AND FEEDING 101 

of which names have been given, the most familiar being 
creatin and creatinin. To these substances is due most of 
the agreeable odor and taste of meats. They are not nutri- 
tious in the ordinary sense of that word, but they do have a 
peculiar effect which may be described as stimulating. 
Every one who has kept a cat or dog has probably observed 
the exciting effect of meat diet, if given in large quantity, 
as compared with an equal amount of nutriment from 
bread, vegetables, or even from milk. Chemists tell us also 
that these extractives seem to prevent waste, while they do 
not repair it. These facts hint at the condition under which 
the meat preparations are useful— when, namely, the appe- 
tite for milk flags or a stimulant seems called for. When 
considered as nutriment, these meat preparations and, above 
all, meat-juice, are not economical, as compared with other 
foods. On the other hand, the meat- juices, owing to the 
greater amount of extractives in them, are the most stimu- 
lating. The amount of juice obtainable from a given weight 
of meat will vary with the piece, the juiciest giving not more 
than one fifth of the weight of the meat, and often not more 
than an eighth can be obtained. In the latter case a half 
pound of meat will give about two tablespoonfuls of juice. 
In beginning its use in the first year, not more than half a 
tablespoonful should be given at first, and only once a day. 
If well borne it may be increased gradually, but carefully. 
It is to be understood that what is said of meat includes 
several kinds, especially those in common use for children's 
broths— beef, mutton, and chicken. For squeezing, beef is 
most convenient, as also for the more concentrated "tea." 
For making broth, however, mutton and chicken are quite 
as valuable and give a variety, which later on is more de- 
sirable than at the age we are discussing. 



THE SECOND YEAR 

In the second year, and indeed for some years afterward, 
milk must remain the chief article of a child's diet. While 



102 THE CENTURY BOOK FOR MOTHERS 

some physicians advise that a child a year old should have 
whole milk, and while it is true that some children can 
at that age digest it, nevertheless the writer is convinced 
that it is not, as a rule, wise to give it. In fact, so far 
as his experience goes, a year and a half seems a better 
time than earlier to cease the dilution of milk entirely. He 
believes that it will be found more judicious to give a larger 
quantity of diluted milk, if it seems to be required, than to 
unduly hasten the increased proportion of proteids, as must 
be the case if a diet of whole milk is given too early. Now, 
if it is borne in mind that the progress is from a food of 
high sugar and low proteid values, to represent breast milk, 
toward cow's milk, which contains nearly equal proportions 
of sugar and proteids and, if of good quality, of fats also, 
it will be at once seen that we have still to dilute the pro- 
teids with some water and to bring up the other solids by 
the addition of some cream and some sugar. The propor- 
tion of proteids, probably at twelve months, should have gone 
up to about three per cent., while the fat may have come 
down nearly to the proportion of cow's milk, and the sugar 
nearly as much— let us say four per cent, for fat and five 
per cent, for sugar. The desired proportion of proteids 
(three per cent.) could be easily obtained by adding one 
part of water to three of milk, but inasmuch as the cream 
with which we shall restore the fat value contains proteids, 
we must allow for this by the first use of more water— 
say one part of water to two of milk. This has brought the 
proteids down to about 2.7 per cent. The addition to this 
of about one ninth part in bulk of good, hand-skimmed 
cream (fifteen to twenty per cent., according to the dex- 
terity of the skimmer) will bring up both proteids and fat 
to the desired figures. Now, as it is probable that our year- 
ling will desire about ten ounces at a meal, the above pro- 
portions would call for six ounces of milk, three of water, 
and one of the hand-skimmed cream. If separated cream 
be bought it can be had of sixteen per cent, strength at 



FOOD AND FEEDING 103 

laboratories and at some dairies. The mixture is still short 
of sugar, the ten-ounce meal requiring about two drams 
(one hundred and twenty grains) to raise it to a five-per-cent. 
sugar strength. In default of scales, a level dessertspoonful 
or two level teaspoonfuls will give this amount accurately 
enough. 

Such a mixture is gradually approximated to the strength 
of pure milk by diminishing the amount of water, cream, 
and sugar in the ten-ounce mixture and making the re- 
mainder of it of whole milk until no modification is deemed 
necessary. 

THE FEEDING OF OLDER CHILDREN 

Of course, the milk or the mixture must still be given 
blood -warm, or at the very least the chill must be taken 
from it. Milk at refrigerator temperatures is unfit for young 
children. As has been already mentioned, the number of 
feedings in a day (twenty-four hours) is usuall}^ to be re- 
duced to five by the age of nine or ten months, certainly 
before the end of the first year. The amount of food taken 
at a meal will during the second year be gradually in- 
creased from eight to ten ounces— if, indeed, the increase has 
not been begun before the end of the first year. The daily 
amount of milk food will therefore be gradually increased 
from forty to fifty ounces. But it must always be remem- 
bered that whenever a meal includes other articles of food 
the amount of milk at that meal must be proportionally 
diminished, especially if the additional food be of animal 
origin (meat, eggs, etc.). Experience has shown that the 
evening meals are best borne if rather light, hence increase or 
changes in diet should not be made after midday, and prob- 
ably, from convenience rather than from any hygienic reason, 
the middle meal of the day, rather than an earlier one, is usu- 
ally the one at which the articles of food other than milk 
are given, and is often called the baby's dinner. A little 
later suggestions will be given as to feeding schedules. 



104 THE CENTURY BOOK FOR MOTHERS 

DIGESTIBILITY OF FOOD 

As new articles of food are introduced into the dietary, 
it is well to keep in mind the objects of each one— that is 
to say, to remember that it is still, and will always be, 
necessary to keep a proper balance between the nutritive 
elements— the proteids, fats, carbohydrates, and salts— in 
the food given. Their relation to the milk given is a part of 
this consideration. The nutritive value is not the only cri- 
terion of food ; digestibilitj^ is, in childhood at least, scarcely 
less important. The articles of food besides milk admitted 
to the dietary of the second year are usually meats, eggs, 
cereal porridges, bread and butter, and fruits. From the 
meat and eggs proteids and fats are obtained. The por- 
ridges and bread are very largely composed of carbohydrates 
in the form of starch, changed or unchanged, but oatmeal 
and whole-wheat flour contain considerable proteids. But- 
ter is practically all fat, while fruits furnish mainly sugar 
and salts. Salts are present in nearly all articles of food. 

THE CHEWING TEETH 

During the first half of the second year the child is get- 
ting its first molars, without which it can do no chewing, 
and, as before stated, its milk food is approaching the com- 
position of whole milk. Until it can chew the child can 
rarely digest any solid food. Hence the additions to the 
milk diet must practically consist of the meat-juices and 
broths already spoken of, and gruels from which all coarse 
particles are strained out. 



MEAT AND EGGS 

With the completion of this first half of the second year 
the chewing teeth are probably present, and the power to 
digest starch and flesh is in some degree gained. This power 
of digestion does not, of course, depend upon the presence 



FOOD AND FEEDING 105 

of the teeth, but these two stages of development do on 
the average coincide sufficiently nearly to allow us to infer 
the one from the existence of the other. Hence at eighteen 
months we may venture to give meat and eggs. Since the 
art of chewing has not been learned, the meat, beef or mut- 
ton, must be carefully scraped from the pulp of a piece of 
rare-done steak, chop, or roast, all tough fibers being dis- 
carded. A good teaspoonful of juicy pulp is enough to 
begin with, and a tablespoonful should be the limit of a 
day's ration during the second year. If the child seems to 
digest the meat well, an egg may be tried. It should be 
really fresh and lightly boiled and slightly salted. Of 
course, the meat and egg cannot be given on the same day, 
and the latter should not be given oftener than twice a week, 
so that its acceptability to the digestion can be noted. With 
the meat or with the egg it is best to give some bread. Chil- 
dren usually like bread-crumb wdth meat- juices or eggs. 
Whether for crumbing or for eating with butter, the bread 
should be distinctly stale, or it may be dried to the condi- 
tion of "oven toast"— 1. e., a thin slice of bread placed in 
the slow^ oven until it assumes a golden-brown color. Until 
the chewing art is fairly obtained, the greater part of the 
bread would better be crumbed. The child can learn to 
masticate the mixture of crumb and scraped meat or crumb 
and egg without danger of large pieces being swallowed. 

ZWIEBACK AND CRACKERS 

Zwieback is much used for children in place of bread. 
It is preferable to fresh pasty bread, but so far as we can 
see has no advantages over the ''oven toast" above-men- 
tioned, save that it is ready-made. This is a doubtful ad- 
vantage. It has the disadvantage of being usually sweet- 
ened. Being ready-made, it would better be heated in the 
oven before serving, a remark which also applies to most 
crackers or biscuit. 

These crackers are also much used for children, probably 



106 THE CENTURY BOOK FOR MOTHERS 

originally from convenience, in many families in which the 
bread-making art was not well developed and the hot-bread 
habit well established. Of the many kinds of biscuit or 
crackers in use, a few are wholesome, more undesirable, and 
some objectionable for children. Those made of whole 
wheat are best, as they have other elements of the grain 
beside the starch. A biscuit of this type much sold in the 
Eastern States is called the ''Educator Wafer." In choos- 
ing from those made of white flour, those which are light, 
free from grease, and free from sweetening are to be selected. 
They should be firm enough to require quite a little chew- 
ing, and not hard enough to be beyond the child's chewing 
powers. Thus, soft powdery crackers, which are simply mois- 
tened with a little saliva and swallowed or washed down 
with a gulp of water, are objectionable on the one hand. The 
very hard water-crackers or educators (not the "wafer"), 
although very desirable for adults are, on the other hand, 
for young children too difficult eating. Sweetened biscuits 
are objectionable, partly because, in this country at least, 
most children eat a very unnecessary and undesirable 
amount of sugar, and still more because a habit is begotten 
which leads children to refuse all food which is not dis- 
tinctly flavored with sugar or in some other way. 

GRUELS AND PORRIDGES 

In connection with the bread we may mention cereal prep- 
arations. Porridges as prepared for adults are rarely 
within the digestive abilities of a child under two years 
of age, and the coarser particles should still be strained out 
and the mixture thinned with warm milk to a gruel-like 
consistency and seasoned with salt. Neither gruels nor por- 
ridge, in the writer's opinion, should ever be eaten with 
sugar. When the starch-converting power of the digestion 
is developed sugar enough is manufactured from the starch 
that is taken in bread, cereals, etc. Before that time milk 
furnishes sugar enough for the child's w^nts, and most of 



FOOD AND FEEDING 107 

the coarse parts of the porridge containing starch are 
strained out. Most of the porridges given to children with 
sugar sprinkled over them are more likely to do them harm 
than good. 

FRUITS 

Fruits are useful as laxatives and, through the salts they 
contain, as preventives of scurvy. In case of the existence 
of that disease, the juice of an orange may be given (usually 
under a physician's direction) at any age. But as a food 
for a child needing no treatment it is permissible very early 
in the second year, sometimes still earlier. It hardly need 
be said that it is not to be given with milk, nor while milk 
is still probably in the stomach, so that it will need to be 
given in an interval between milk meals, say when the inter- 
val is two thirds gone, or it may be given with the meat and 
bread meal, as a dessert, if no milk is taken. By the age of 
eighteen months some cooked fruits are permissible, and if 
constipation exist probably desirable. Those most generally 
procurable of the suitable sorts are apples and prunes. 
The apples should be thoroughly baked or stewed, with as 
little sugar as will correct an acid taste. The pulp should 
be carefully strained, or, in the case of the baked apple, 
carefully fed to the child with a spoon by the mother or at- 
tendant. Prunes must be very carefully cooked and sifted. 
The writer believes that in season the pulp of thoroughly 
ripe and fresh peaches is one of the safest forms of fruit. 

POTATOES 

It will probably be noticed that the potato has not been 
mentioned among the articles of diet in the second year. 
This is because, in the writer's experience, it seems better 
deferred until the completion of dentition, or until the end 
of the second year. Many children are given potatoes to 
eat much earlier, often before they are eighteen months old, 
and very likely some children can digest them in the second 



108 THE CENTURY BOOK FOR MOTHERS 

year. Nevertheless, the writer feels justified in advising 
their postponement until the end of this year. Whenever 
they are given, they must be baked or roasted thoroughly, 
lightly broken up with a fork, properly seasoned with salt; 
upon them, in addition, may, if desired, be put cream or beef- 
juice. Butter upon a hot potato is not advisable for young 
stomachs any more than melted butter elsewhere. 

THE FIVE MEALS 

The changing of the kinds of food has thus gradually con- 
verted the five bottles which constituted the diet at the end 
of the first year into five meals, which will continue for some 
time to come. These meals may be denominated as : 

The rising meal, usually 6.30 to 7 a.m. 

Breakfast (or the after-bath meal) . . . 9.30 to 10 a.m. 

Dinner 12 M. to 1 p.m. 

Afternoon meal or supper 3.30 to 4 p.m. 

The bed-meal 6.30 p.m. 

The rising meal is usually a bottle of milk or a cup of milk 
with bread or cracker. The bed-meal should be a small one 
of milk. Breakfast is the meal at which the cereal is intro- 
duced with milk. The afternoon supper is very similar, 
but bread or toast is more commonly used, as cereals are 
sometimes inconvenient to prepare twice a day. The dinner 
or midday meal is that at which the meat juices, broths, and 
scraped meat are introduced, as well as any of the admis- 
sible desserts spoken of. 

Of course, at any meal where bread is given with milk, 
the former, stale, should be broken into the milk, but the 
child should be taught to chew the bread and not swallow the 
softened mass immediately upon putting it into the mouth. 

FEEDING AFTER THE SECOND YEAR 

With the opening of the third year, if the child be a good 
eater, it may be desirable to unite the supper and the bed- 



FOOD AND FEEDING 109 

meal, the forenoon and midday meal being made propor- 
tionately later, say 10 :30 to 1 :30 respectively. If the child 
be not so good an eater or one of those who does not readily 
go to sleep when put to bed, the fifth meal, in the shape of a 
cup of milk, may be continued for a while. The four-meal 
schedule once adopted is generally continued until perhaps 
the sixth year. Its interruption seems to be brought about 
not so much by any hygienic theories, or even by the second 
dentition, as by the exigencies of school life. Even then a 
snack at recess is often provided for. In England even 
adult laborers, at least in some districts, adhere to a meal 
variously known as a " tenner " or ' ' elevener, ' ' from its cus- 
tomary hour. 

GENERAL RULES FOR DIET 

More important than the precise number or hours of meals 
is regularity in regard to the number and amount. Be- 
tween these adopted hours there should be no eating. "Be- 
tween-meal" eating and ''tastes" of adults' meals should be 
strictly forbidden to children. On the other hand, it is un- 
just to take them to table with their elders, who are eating 
savory articles of food which they cannot be allowed to 
have. It is better that the child have its meals by itself 
until it can share with propriety the meals of its elders 
or can understand that there are reasons for its being 
denied. 

The child should be allowed plenty of time for its meals, 
but should not be allowed, however, to dawdle over or play 
with them. It should not be forced to eat when it evidently 
does not desire to do so. It should be taught to chew its food 
carefully, but should have food given to it which it can 
chew without fatigue. When the child has had enough, let 
it stop eating, rather than try to stimulate its appetite by 
giving unsuitable dainties. This is not intended as a for- 
bidding of palatable, well-cooked, and properly seasoned 
food, for palatability is a great aid to digestion. But it is 
intended to prevent the very common false method of feed- 



110 THE CENTURY BOOK FOE MOTHERS 

ing children, which results, to use a country phrase, in their 
being *'cake hungry but never bread hungry." 

Rules for diet and hygiene are generally arranged for 
states of health. When a child is ill, the physician in atten- 
dance will specifically dictate the food. In minor cases of 
illness or of indisposition the great rule is to diminish the 
amount of food and make it more easy of digestion. So far 
as milk food is concerned, this is easily accomplished by 
simple dilution. In regard to other food, in a general way 
it may be said that solids are to be set aside, or, if used, only 
the more digestible ones. 

In warm weather the appetite is generally less than at other 
times in adults, and thus the proper diminution of the amount 
of heat-producing foods is accomplished. Children need some 
oversight in this regard. Usually the amount of food neces- 
sary is less, but it is to be borne in mind that an infant on 
liquid food may in hot Aveather take an undue amount from 
thirst, and that it Avould be quite as contented and much 
more comfortable if given occgisional drinks of water and 
less food. Again, it is to be remembered that older city 
children, at least, are much more active in out-door play in 
summer than in winter, and for this reason may demand 
an increased amount of food on that account which will off- 
set the diminution which should be made on account of 
warm weather. 

It is also to be remembered in determining the amount 
of food at any time that it is no question of how much a child 
may be able to eat, nor in selecting food should we ask. Can 
the child eat this or that thing without evident injury or 
prompt discomfort? But the question is, "Will this amount 
of this kind of food be of advantage to the child? And 
whenever doubtful indulgences are considered one must re- 
flect whether harm may come from them, either through 
remote indigestion or the causing of dissatisfaction with sim- 
pler and more wholesome food. Too often impulse or lazi- 
ness, rather than deliberate thought and experience, decides 
the matter. 



FOOD AND FEEDING 111 

THE THIRD YEAR AND THEREAFTER 

From the beginning of the third year, or that part of it when 
the teething is complete, until the beginning of second den- 
tition there is a gradual increase of the variety, as well as in 
the amount of food. But it is never to be forgotten that 
the dietary is by no means that of an adult. Out of the 
immense variety of articles of food and of methods of pre- 
paring them suitable for the latter, only a small part can be 
wisely permitted to children. 

Of the various groups of food— flesh, fowl, and fish, 
with eggs and milk, vegetables and cereals, fruits and gar- 
den produce— we shall point out below those which we con- 
sider really desirable. Of those undesirable not many will 
be mentioned, chiefly those which, while objectionable, are 
from some error often given to children. 

"ANIMAL FOODS" 

Of milk, so much has been said that no detail need be 
again gone into. It usually forms a considerable part of 
a child's dietary until the second dentition begins, and dur- 
ing the third and even the fourth year it is the main re- 
liance. From meals which include other proteids — meat, 
eggs, etc.— in any considerable amount, milk is as well 
omitted, or, if used, it should be in less quantity. 

Cream, Avhen no longer added in milk modification, is still 
very useful. Its great uses are as a laxative article of food, 
and as a more digestible form of unsalted butter, although 
it does still contain some proteids. Like butter, it can be 
used to increa.se the palatability or the ''richness" of food, 
and of itself makes a harmless sauce to many articles other- 
wise dry. 

THE VALUE OF EGGS 

Eggs are very rich in protein and fats, their protein value 
being not much behind that of an equal weight of good 
steak. They form a useful change in the third year and 



112 THE CENTURY BOOK FOR MOTHERS 

afterward, but should be given only occasionally in the ear- 
lier years, certainly not daily, lest— if for no other reason— 
an inconvenient dislike on the part of the child be engen- 
dered. It is also wise to have an interval between the days 
on which eggs are given, so that if any idiosyncrasy regard- 
ing them exists it may be the more readily detected. It is 
probably these occasional personal peculiarities which have 
given rise to the popular dictum that "eggs are bilious." 
They should be given only soft-boiled or poached- i. e., 
dropped into boiling water — and for these purposes only the 
very freshest eggs are suitable. If really fresh eggs cannot 
be obtained, the child will be better without them. 

VARIOUS MEATS 

Of the great variety of meat foods, very few are suitable 
for children. All salted or smoked meats, all game, all 
preparations of meat— such as sausage— intended to be eaten 
uncooked are at once set aside. The choice as to "butchers' " 
meat is practically only between beef and mutton. Veal is 
quite unsuitable, and lamb, unless we use the word as a com- 
plimentary name for young mutton, is not nearly so digest- 
ible as the mature meats. The writer believes that this is 
true of all flesh of immature animals. Pork is the most in- 
digestible of all meats usually sold. Bacon, it is true, is far 
more digestible than other pork food, but this advantage is 
generally more than destroyed by cooking the meat to crisp- 
ness, in which state few young children can digest it. 

Beef, then, in the form of steak or roast beef, and mutton 
roasted, boiled, or as a chop, constitute the child's variety of 
meat. Mutton is the more digestible of the two, but for 
some reason this fact seems to be less well known in this 
country than formerly. The meat should be cooked to the 
condition known as rare— that is to say, cooked beyond the 
blue stage, so that its juices run freely as it is cut, but still 
red, and not brown, in the interior. 

Of poultry, only the fowl and the turkey are permissible, 



FOOD AND FEEDING 113 

and in the earlier years only the white meat of the bird. 
Young birds are more tender than old ones, but they should 
be fully grown. They should be thoroughly cooked. The 
flesh of ducks and geese have no place in the nursery. 

The same may, as a rule, be said of parts of animals used 
as food for adults, such as liver, kidneys, and the like. Both 
tripe and sweetbreads are digestible, but as usually cooked 
their digestibility is destroyed, and in any case their use in 
the nursery should be forbidden, unless they are thoroughly 
and simply stewed and served ^dthout sauces, in which case 
they are often insipid. 

Made dishes and hashes must likewise be disapproved of, 
because they are, as a rule, made of the less desirable parts 
of meat previously cooked and served. They are also usu- 
ally overseasoned and overdone. A fine mince made from 
previously uncooked meat or carefully made from good parts 
of a roast and not unduly seasoned or sauced may sometimes 
be given in an emergency. 

It seems hardly necessary to call attention to the fact that 
nothing intended for nursery food is to be fried. Even 
skilful frying in the fat kettle is undesirable, and too many 
American cooks have too far forgotten this art to make it 
safe to admit frying at all. 

FISH AS FOOD 

Fish for young children should be only of a few digestible 
kinds, and should be particularly fresh and sweet, even more 
so than if for the use of adults. This requirement of fresh- 
ness restricts the use of fish considerably, since in the winter 
in many places fish can be had only after it has been kept a 
long time on ice. Fish which are very fat are not very 
digestible, hence the tribe of mackerels, including the blue- 
fish, and some of the herrings are pretty strong for a child's 
stomach. The same is true of the eel, as well as of the salmon. 
The cod, when young and in season, the haddock, the hali- 
but, the striped bass, have all white flesh which is nutri- 



114 THE CENTURY BOOK FOR MOTHERS 

tious and digestible, and the fish is large enough to give good 
pieces for boiling or broiling, the only ways in which fish 
should be prepared for children. The flesh of the large 
flounder, sometimes called plaice, is good boiled, but rather 
dry; that of the squeteague, or weakfish, is good broiled, but 
too soft for boiling. It is a fish which preeminently needs 
to be used very fresh to preserve its flavor. The black sea- 
bass of Northern markets and the tautog (called blackfish 
in New York) are both good fish. Southern markets have 
many excellent fish, but they are not so good for children's 
use if transported. Of fresh-water fish, few are market- 
able far from the place of their capture in a condition suit- 
able for the nursery table. The best, when fresh, are the 
trout, the whitefish, the yellow perch, and young pickerel. 
Black bass from clean waters, the white perch, and perhaps 
the pike perch may be admitted. The objection to most of 
these fish is their size, which makes them too small for boil- 
ing and often for broiling. They are therefore usually fried, 
which, as has been said, is not a good method of cooking for 
young children. 

Salt fish and smoked fish need only be mentioned as unde- 
sirable. They are too difficult of digestion. 

Boiled or broiled fish must not be served with fat sauces. 
Broiled fish must not be buttered in broiling. A little salt 
put upon them some time before the broiling improves the 
flavor. For boiled fish no sauce, or the simplest cream sauce 
only, can be allowed. 

Shell-fish need but a word. Except the oyster, none are 
fit for the nursery, and even this excepted one is rather an 
indulgence than a desirable food for children. It can be 
given only stewed. It makes, however, one of the many 
broths which are now permitted. Oysters give an agreeable 
flavor to the milk and other ingredients in which they 
are cooked, even if the oyster itself be not eaten. Clams 
may be used in the same way, but the broth must be strained 
to get rid of the clams themselves, which are quite unsuitable 
for children's food. These broths are very appetizing, but 



FOOD AND FEEDING 115 

their nutritive value is largely in the milk added, as well 
as in the cracker or flour thickening, if any be used. 

SOUPS 

Broths or soups of various sorts, besides those before de- 
scribed, may be allowed to children, but they should be plain. 
Most soups into which vegetables enter require to be strained, 
so that the latter may give flavor wdthout the more or less in- 
digestible substances. The potato soup, if well made, is an 
exception, the vegetable making an excellent puree. Soups 
of meat can be made more nutritious, as well as varied, by 
the addition of rice, barley, or vermicelli or Italian paste. 
In making soups for the nursery it is to be borne in mind 
that they must be as nutritious as practicable, but digestible 
certainly. No so-called rich soups are permitted, because 
nearly always the ''richness" is due not to nutrients so much 
as to indigestible additions. 

VEGETABLES 

The potato has already been mentioned as the first vege- 
table allowed to children. It continues through childhood, 
and through life in fact, the most generally useful of vege- 
tables. During the whole of the period which is under con- 
sideration— i. e., until the beginning of second dentition— it 
should still be given baked. Boiled, it is as a rule less light 
or ''mealy." Stewed, it is of doubtful propriety, and fried 
or sauted, it is distinctly objectionable. Sweet potatoes are 
less desirable, as a really mealy one is not very common, even 
the best having an adhesiveness far beyond that of the best 
white potatoes. If given at all, they should be baked and 
given only to children over five. 

This objection of toughness and indigestibility is still more 
pronounced against the immature white potatoes sold as 
"new potatoes." However palatable they may be, they 
must be denied to young children. This, however, does not 



116 THE CENTURY BOOK FOR MOTHERS 

apply to the fresh crop of mature potatoes. The white 
potato has the advantage of being available throughout the 
year. 

During the season of fresh vegetables there are a number 
which are wholesome even during the third and fourth year. 
The choice of winter vegetables is more restricted. 

Two or three things may as well be first mentioned. First, 
a young child should eat no uncooked vegetables. All vege- 
tables should be thoroughly cleansed before cooking, all im- 
perfect parts being discarded. Most vegetables, if boiled, 
lose less of their value and flavor if the water be slightly 
salted. Lastly, and perhaps most important, all green vege- 
tables must be eaten while quite fresh, or their advantages 
as articles of food are doubtful. The effect of each article 
upon digestion should be watched. Among the tcnderest and 
most digestible of the summer vegetables are asparagus, peas, 
and string-beans. 

Asparagus-tops cooked very tender, served without sauce 
or with cream only, are usually digestible in the third year. 
The odor communicated to the urine by the vegetable is dis- 
agreeable, and sometimes causes alarm to those mothers who 
had not previously noticed it. 

Peas should be given only when especially tender. No 
amount of cooking can make an old tough pea soft. In fact, 
it is claimed that they grow harder in boiling, and they can 
hardly be less refractory to digestion. 

String-heans must be equally tender and be well cooked 
and well chewed. 

Some varieties of beans eaten without the pods may be 
given if tender and thoroughly cooked. But it is to 
be noticed that they vary, and even different messes from 
the same source vary very greatly as to tenderness, and 
unless the mother can make a daily test of this they are 
better not given. Tough beans are among the most indi- 
gestible of fresh vegetables. Dried beans in the form of 
baked beans, while a very nutritious form of food, are not 
within the digestive abilities of most children of the age of 



FOOD AND FEEDING 117 

six or under. But in the fifth or sixth year a well-made 
bean or pea-soup may agree. Peas and beans contain such 
a large amount of proteids as to quite equal, pound for 
pound, the best lean beef, besides much starch. When the 
fat of pork is added it is evident why the combination is of 
such high repute as a food. Nevertheless, children, as well as 
adults of feeble digestion, would better not try such heavy 
food. 

Of the vegetables which can be had in good condition 
later in the year we may mention the onion, cauliflower, 
and spinach. 

The best onions are called Spanish or Bermuda, their flavor 
being less harsh than others. For the nursery they are to 
be boiled or baked, the former being, in the Avriter's judg- 
ment, preferable. They must be cooked until thoroughly 
tender. They are acceptable without sauce, but if sauce be 
desired it should be of cream, not melted butter. 

Cauliflower is the only plant of the cabbage family which 
should be allowed to young children. It should be boiled 
and served in the same manner as directed for onions, but 
it is not an easy vegetable to prepare properly for the 
nursery. 

Spinach, in the form of a puree, is one of the stand-bys of 
the nursery table in winter. What has been said about 
cleansing and boiling of vegetables applies emphatically to 
spinach. For children it must be put through a sieve or a 
fine colander. It should not be given in the rustic form of 
•'greens." Like the onion and perhaps the cauliflower, it 
is accounted slightly laxative, but it cannot be charged, as 
they sometimes are, with causing gas. It is said to contain 
an appreciable amount of iron, which makes it valuable in 
the dietary of winter and spring. 

The quantity of all these vegetables must at first be small, 
a single onion, a dessertspoonful of cauliflower or of spinach, 
for instance, and gradually increased if found to agree. 

Celery, carefully prepared by boiling or prolonged stew- 
ing until thoroughly tender, is an acceptable vegetable, but 



118 THE CENTURY BOOK FOR MOTHERS 

its nutritive value is not great. Of the vegetables known in 
common speech as "roots"— turnips, beets, carrots, parsnips, 
etc.— few are tender or digestible enough for young children. 

The heet, if it could be gotten tender and thoroughly 
cooked, might be useful, but in practice the writer has rarely 
found it properly prepared, and has been obliged to conclude 
that the toughness of the vegetable is not properly appre- 
ciated in the kitchen. 

The carrot, to be allowable, must be very thoroughly cooked 
and put through a sieve, and it is doubtful if its accepta- 
bility to the childish palate and its nutritive value are suffi- 
cient to repay the trouble. The vegetable is mentioned only 
as a resource for occasions when something with salts in its 
composition is needed and nothing better is at hand. 

The question is sometimes asked, Are canned vegetables 
proper for use in winter? The answer depends upon the 
quality of the vegetable. Some kinds of vegetables preserve 
their original qualities well, some do not, and of the for- 
mer the wares of one factory may be good and tender, those 
of another stale and tough. In many places the alternative 
is to use canned goods in the winter or to go without green 
vegetables altogether. In other places the best canned vege- 
tables seem to be really better than those brought from a long 
distance in cold storage. No fixed rule, therefore, can be 
made. Each article must be judged by itself. There are, for 
instance, canned peas in the market as tender and nearly as 
palatable as those freshly picked; there are others which are 
burdensome even to an adult stomach. In every case of 
doubt err upon the safe side, and refuse to give the vege- 
tables to the child. 

BREAD AND CEREALS 

The directions given for their use in the second year are 
still valid. No fresh breads should come into the nursery. 
Bread should be at least a day old, and the whole list of 
biscuits, muffins, etc., are tabooed. All the ordinary cereal 



FOOD AND FEEDING 119 

preparations, if well cooked, are permissible and for the 
most part desirable. Oatmeal is a standard. AVheaten 
preparations, of numberless trade names, preferably those 
not of the coarsest sort, are excellent, especially as a change 
from the oatmeal or when the latter seems to be the cause 
of skin irritation, as it occasionally does. There is also a 
long range of preparations of Indian corn, such as Indian 
m.eal, farina, hominy, and, for those children old enough to 
chew well, samp and hulled corn, meaning that hulled by 
machinery; that hulled by the use of alkalis can be given 
only if very carefully washed free from the alkali. Rice is 
also useful. Tapioca and sago used in the adult dietary 
are not so desirable for children as ordinarily prepared. 
Their place is really as a component of nursery desserts, 
which should be so delicately made that the tenacity of these 
ingredients may be overcome. 

MACARONI 

Macaroni may be mentioned in connection Avith the cereals. 
Being made from a peculiar Italian Avheat, the real maca- 
roni is rich in gluten, and, while very nutritious, is some- 
times tough and resistent to digestion. For nursery use, 
therefore, the finer kinds, vermicelli and spaghetti, are pref- 
erable. It is quite possible by careless cooking to render 
the macaroni a disagreeable, pasty mass. This is best pre- 
vented by keeping the water boiling while the broken pieces 
are dropped in, a few at a time, so that the heat shall not 
be noticeably checked. For nursery use it must not be 
served with cheese, tomato, or other relishes, but plain, with 
milk or cream. 

DESSERTS 

It is left to speak of such things as constitute suitable nur- 
sery desserts. They are not very many, and must be all 
rather simple. Perhaps the commonest is junket, otherwise 
known as rennet custard or slip. It is, of course, merely an- 



120 THE CENTURY BOOK FOR MOTHERS 

other, and usually an attractive, way of giving milk. This 
should be borne in mind if the meal has contained already 
milk or much proteids of any sort. Similar desserts are 
custards, baked or boiled. They are equally rich in proteids, 
to some persons less digestible because of the egg used, and 
are therefore not to be used so early as junket, but are usu- 
ally well borne, in moderate amount, at two and one half 
or three years. 

Rice puddings and bread puddings may be given by the 
latter date if made simply. Very good rice puddings can be 
made without eggs, and, however made in other respects, 
should be free from the too common fault of excessive sweet- 
ness. Rice pudding is usually quite as agreeable cold as 
hot, but the same is not true of bread puddings. The ob- 
jection to ice-cream is less its composition than its tempera- 
ture. It is not helpful to digestion to take any considerable 
amount of very cold substance into the stomach as a part of 
a meal. In the third year only perhaps a dessertspoonful is 
to be allowed, and that should be partially softened before 
giving it. Only simple ice-creams should be used. 

No pastries of any sort should be given, and if any cake 
only sponge cake or simple gingerbread. Many desserts, how- 
ever, can be made from fruit, either in its natural state or 
cooked. The early use of oranges and of stCAved prunes has 
already been spoken of. Both, especially the orange, remain 
for a long time acceptable to the childish palate. Apples are 
not very digestible uncooked, but the baked apple is much 
more so. They are best given baked, either alone or with 
cream. There are many very tasty dishes made from apples, 
such as *' Brown Betty," and rich mixtures with jelly and 
cream, which are not, in the writer's belief, very digestible. 
As a variant, stewed apple-sauce is good. But it is to be noted 
that for either baking or stewing good sweet apples should 
be chosen, else the amount of sugar needed to make them 
palatable is more than is well borne by the digestion. In 
the third year the pulp of sweet apples may be given un- 
cooked if it be scraped up finely with a spoon. Pears are 



FOOD AND FEEDING 121 

akin to apples. A very good pear is often accounted more 
digestible than an apple. The coarser varieties of pears can 
only be eaten cooked. The chief objection to the pulp of 
a fine pear is that in a good many stomachs it seems to excite 
acidity, and is therefore (for such persons at least) not 
desirable at a time when the dietary contains much milk. 

FRUIT 

Most berries are scarcely worth considering in the early 
years ; they disturb the bowels more frequently than is com- 
pensated for by their little food value. The strawherry in 
a perfectly sound and ripe condition may be tried cautiously, 
however, in the third or fourth year, cautiously because 
there exist more idiosyncrasies in regard to this fruit than 
probably in regard to any other. 

One of the most persistent of winter fruits is the banana. 
Quite a little popular controversy has arisen as to its digesti- 
bility. The question cannot really be discussed in the North- 
ern States, to which the fruit comes in an unripe state to 
be ripened. It is also usually bought for use imperfectly 
ripened. So that whatever be the truth about the banana 
where it grows, as bought in the North it is not suitable for 
children under seven years. But, cooked, the writer has 
found it wholesome and generally liked by children. Ba- 
nanas are as easily baked in their skins as are apples. The 
skins turn black in the cooking. They are easily removed, 
leaving a soft pulp rather less firm than that of a baked 
apple, which is very palatable without any addition, but 
cream may be used if desired. 

Grapes come rather early into use, but for little children 
the seeds and skins must be removed, so that the solid pulped 
grapes, of which the white Malaga grape is the type, are 
practically the only ones which can be used. 

Melons belong to the doubtful articles, because so many 
melons are poor. The pulp of a really good melon, whether 
watermelon or canteloupe, is very tender and, we believe, di- 



122 THE CENTURY BOOK FOR MOTHERS 

gestible. Owing to the uncertainty of the melon's character 
until it is cut it cannot be ordered for the nursery. It can be 
given only when one of the proper quality actually appears. 

The peach has already been spoken of. 

Of dried fruits, dates and figs are sometimes given. They 
are of doubtful propriety unless they are cooked, as their 
flesh is too tenacious for children of an age at which they 
rarely chew anything very well. 

Nuts can be only mentioned to be forbidden. 

The list of foods above given has been made as long and 
as inclusive as the writer felt proper. Articles not men- 
tioned are to be understood as, in his opinion, undesirable or 
objectionable. 



WATER AND OTHER DRINKS 

Of drinks none are proper but water. If the w^ater-supply 
be of doubtful purity the water may be filtered, if a really 
good filter is at hand. If not, it may be strained through cot- 
ton or flannel and boiled and set aside to cool before using. 
Aerated waters may be given in small quantities only. Milk 
should be always thought of as food, although its compo- 
nent water makes it a quencher of thirst. Water should 
be very early offered to children in small quantities, as their 
thirst is very often mistaken for hunger. Tea and coffee 
are never to be allowed, and wine or beer only under a physi- 
cian 's specific direction. As an occasional article of diet 
light cocoa beverages may be used in the later years of the 
period under discussion. But even these are better omitted. 

OBJECTIONS TO SWEETS 

The writer believes that in the foregoing list of articles of 
food for young children he has included all that are admis- 
sible. All others being considered as usually inadmissible, 
no list of excluded articles is made. It is, however, perhaps 
necessary to make especial mention of candy and sweets as ob- 



FOOD AND FEEDING 123 

jectionable. So long as a child's diet is largely made up of 
milk food it gets an ample amount of sugar. Later it gets 
in its cereals, bread, and potato much starch which is con- 
verted by digestion into sugar. All through life in most 
civilized countries, certainly in our own, food is generally 
sweetened beyond the needs, and very frequently beyond the 
toleration of the average system. 



IX 

DISORDERS ASSOCIATED WITH 
IMPROPER FEEDING 

IN connection with the subject of feeding it is proper to 
mention some disorders associated with or dependent 
upon improper diet. First may be mentioned rickets. 

SYMPTOMS OF RICKETS 

This disease, called scientifically rachitis, is a general one 
affecting all parts of the system, but being most striking in 
its effects upon the bones of the body, which, through an 
arrest in the ossifying process, become soft and often dis- 
torted. It is a disease which in well-cared-for children 
rarely reaches a pronounced degree. The striking bony 
changes spoken of are usually seen among the poor, and in 
this country most of the cases are found in the children of the 
negroes and Italian immigrants. The milder cases of rickets 
are often seen among the well-to-do, but, the early symptoms 
being recognized, are corrected before deformitj^ has resulted. 

Rickets usually occurs within the first two years of life, 
and especially after weaning or the failing of an adequate 
breast-supply ; both too early and too late weaning may lead 
to improper or insufficient feeding. 

The most noticeable symptoms are the following: The 
earliest manifestation is often overfatness, with constipa- 
tion. Sometimes diarrhoea is present, or alternates with the 
constipation. The child perspires more than is natural, es- 
pecially about the head and neck. Teething is backward. 

124 



DISORDERS ASSOCIATED WITH IMPROPER FEEDING 125 

It should be said, however, that this symptom is not alone 
conclusive of rickets— if, indeed, any one of the symptoms 
above given alone be— since family peculiarity has much to 
do with the time of the eruption of the teeth. 



CHANGES DUE TO RICKETS 

If the disease advances far enough to produce bony changes 
the most common are the following : The head is prominent in 
places, especially in the frontal and parietal bones, making 
the naturally rounded contours of the baby's head rather 
more angular or square, as is usually said. The face some- 
what shares in this angularity. Often the skull-bones, on 
handling, are felt to be softer and thinner in places than 
they should be. This is usually most marked at the back 
of the head. The chest, owing to the yielding of the ribs, 
takes the shape known as pigeon-breast or keel-breast— that 
is to say, there are depressions at the sides not far from the 
line of the nipples, while the breast-bone and the middle of 
the chest project like a keel. This change of shape dimin- 
ishes the capacity of the chest, and renders more important 
any bronchitis or other lung trouble which may occur, and 
a tendency to which may be favored by the rachitic condi- 
tion. Sometimes the points where the ribs join their car- 
tilages are increased in size, and those rows of knobs have 
gained the name of ''the rickety rosary." The long bones, 
when affected, bend, making, according to the parts subjected 
to the pressure of the w^eight of the body, various distortions, 
among which knock-knee, bow-legs, and curved shins are the 
most familiar. 

CAUSES AND CURE OF RICKETS 

The cause of rickets is undoubtedly due to defective feed- 
ing, or feeding inappropriate to the digestive powers of the 
child. The exact form of unsuitableness may vary greatly, 
but actually the errors by far most frequently recognized 



126 THE CENTURY BOOK FOR MOTHERS 

are an absence or deficiency of fat in the food and the giving 
of starchy food when it cannot be digested or in greater 
amount than can be digested. It therefore is likely to occur 
in infants who are given the food of adults and in those fed 
upon so-called infant foods, which are very starchy and 
deficient in fat. 

The disease usually develops rather gradually, and is re- 
covered from with proportionate slowness. Its cure consists 
essentially in removing its cause— that is to say, in correct- 
ing the errors in diet, as w^ell as in hygiene, if any exist. 
Medicinal treatment wisely directed may also assist the cure. 

INFANTILE SCURVY 

Another disease, once called acute rickets from an erro- 
neous idea of its nature, arising from dietetic error is scurvy. 
It is also, for distinction from ordinary scurvy, called in- 
fantile scurvy or scurvy-rickets. 

The symptoms likely to attract the attention of the 
mother are these: The child is restless, or may be peevish, 
but it will generally be found that it is relatively contented 
if left alone, but cries if touched. It has diminished appe- 
tite, looks pale, and may sometimes have disordered bowels. 

The condition of the blood is changed, and, as in ordinary 
scurvy, may escape from the blood-vessels in almost any 
part of the body. The commonest situations are in the 
gums, which are in that case tender and bleeding, but this 
symptom is not likely to occur before the teeth begin to come. 
* ' Black-and-blue spots" appear on the skin, sometimes giv- 
ing the appearance of a black eye, or, if the bleeding be into 
the loose tissue of the orbit, the eye may protrude somewhat. 
A very striking characteristic is the swelling of the limbs, 
especially the lower, due to bleeding beneath the periosteal 
covering of the bone. The swelling is spindle-shaped or 
pear-shaped and very tender to touch. More rarely blood 
escapes from the bowels or with the urine. Occasionally, in 
connection with the periosteal bleeding in the lower limbs, 



DISORDERS ASSOCIATED WITH IMPROPER FEEDING 127 

the bones may be fractured. But the changes already de- 
scribed as due to rickets are not marked unless the child be 
also afflicted with that disease. 

CAUSES AND CURE OF SCURVY 

This disease, unlike rickets, may occur in children more 
carefully looked after, although not confined to them. The 
essential dietetic error seems to be a lack of freshness in 
the food— that is to say, it rarely occurs if the infant gets 
fresh milk as food, but much more frequently if the diet 
is of condensed milk or dry prepared foods. It sometimes 
occurs when fresh milk is the food if the milk is sterilized 
too long or at too high a temperature. The use of fresh 
food in the form of meat-juice, for those infants old enough 
to take it, seems to be useful both as preventive and curative. 
The high value of fresh vegetables for both these pur- 
poses is well known as regards the scurvy of adults, and the 
same is found true in infancy. But the available kinds are 
few, since the disease usually occurs between six and eight- 
een months. Most frequently used, both because it is palat- 
able and easily borne, is orange juice. The giving of the 
juice of a half or a whole orange of good size, according to 
the age of the child, once a day is generally followed by 
prompt improvement of the symptoms and by cure. The 
juice of grapes and the pulp of apples have also been given. 
In cases where fruit juices for any reason cannot be had, it 
has been found that fresh vegetables, such as carrots or 
potatoes, cooked in beef soup, impart an anti-scorbutic value 
to the soup, although the vegetables are carefully strained 
out. A very thoroughly cooked potato, beaten up into a 
cream with milk, may also be given to advantage; at first a 
teaspoonful and later a larger quantity being added to each 
bottle of food. 

HABITUAL CONSTIPATION 

Constipation is of many kinds, and may depend upon a 
very great variety of causes. But in popular language the 



128 THE CENTURY BOOK FOR MOTHERS 

word is generally used to signify habitual constipation, and 
since in infancy this condition commonly depends upon 
dietetic or hygienic errors it is proper to consider it in con- 
nection with those diseases due to faulty food or feeding. 
If the child is suckled the constipation may depend, or at 
least seem to depend, upon constipation in the mother, or it 
may be due to a faulty composition of the breast milk. If 
the child be bottle-fed the usual faults of composition in 
the food are too little fat, with or without an excess of 
casein. The value of the fat as a laxative has already been 
alluded to. It will be remembered that in typical breast 
,milk the percentage of fat was put down as three or four 
\times that of the proteids. It will also be remembered that 
at first the percentages in the artificial food mixtures rec- 
ommended were kept below^ those of the standard breast milk. 
It does seem, however, that if their relative proportion be 
not much disturbed the bowels keep in pretty good condi- 
tion while the actual percentages are still low. As in later 
infancy higher proteid percentages are reached, and the 
Xjroteid is chiefly casein, it is sometimes not practicable to 
proportionately run up the fat percentages. The digestion 
rebels against such an amount of fat. Nevertheless, the 
best results are reached through the increase of the fat 
percentage in the food toward, but short of, the limit of tol- 
erance. It will, of course, be at once seen why constipation 
so often follows the use of patent foods, which are prac- 
tically devoid of fat, some of which, however, do contain 
considerable dried casein. 

When the child is suckled and the milk is deficient in fat 
it is often very difficult, with the best theoretical feeding of 
the mother, to modify sufficiently the composition of her 
breast milk. In such an emergency, Dr. Holt has suggested 
the feeding to the infant just before each nursing a tea- 
spoonful or more, as may be necessary, of cream. 

A number of hints concerning the subject of constipation 
and various digestive disorders will be found, under their 
respective headings, in the second part of the book. 



DISORDERS ASSOCIATED WITH IMPROPER FEEDING 129 

HYGIENIC TREATMENT OF CONSTIPATION 

After the first year and until a pretty varied vegetable 
diet is permissible— a period of about three years— a good 
deal of difficulty is often experienced with constipation. 
All through this period fats are useful. Cream is the 
best form, but in its absence butter and other animal fats 
may be used, the effect upon digestion being watched. 
When the laxative cereals can be eaten with cream they 
diminish the difficulty. So do the laxative fruits already 
mentioned. And the use of green vegetables or other laxa- 
tive vegetable food generally enables the parent to control 
the condition of the child's bowels, if attention is paid to 
certain hygienic rules, without the resort to medicinal 
remedies. 

It ought to be mentioned that the free use of water is as 
useful in many cases of infantile constipation as with adults, 
especially when the evacuations are very hard and dry. The 
water is best taken on rising, before food, not given to dilute 
a meal. 

The hygienic considerations just alluded to relate to the 
posture, time, and regularity of defecation. As to posture, 
it hardly need be said that the natural one is that of squat- 
ting. In it, with the body slightly bent forward, all the 
muscles used in evacuating the bowel are in the best posi- 
tion for efficient action. When, however, a child is put upon 
its chair commode its posture is often such as to render the 
expulsion of hard faeces exceedingly difficult. The trunk 
is bolt upright, the feet dangle from a seat which is too 
high, and the expulsive power of the abdominal muscles is 
reduced to a minimum. Besides, the aperture in the seat 
of the chair is so wide that no support is given to the seat- 
bones, the fleshy buttocks are crowded together instead of 
separated, and the descent of the parts necessarily prelimi- 
nary to evacuation is much hindered. If a child be rachitic, 
its difficulties are in every way increased. In all cases of 
constipation it is better to use a low vessel than a chair, 

9 



130 THE CENTURY BOOK FOR MOTHERS 

unless the latter be a very low one. The writer was once 
consulted concerning a child because it would never use its 
chair, no matter how long it was left upon it; but immedi- 
ately afterward would go to a corner of the room for its 
evacuation. The poor infant could not do otherwise, for the 
reasons just given. 

The element of time is important. The matter to be evac- 
uated may not be in the lower bowel, or even if it be there, 
the impulse to expel it may not come immediately, and a 
certain amount of delay becomes necessary. "When chil- 
dren are of school age this factor becomes a pretty impor- 
tant one in inducing habitual constipation. Time enough 
between breakfast and school-time cannot be allowed, and 
the function is forgotten until some time when it becomes 
imperative. Therefore it is far better that school children, 
if habitually constipated, shall be obliged to take some other 
time of the day, one which they can always devote to the 
purpose, preferably when the parent or attendant can know 
of the result. 

This last requirement, regularity, is so important that 
it is very generally appreciated. It cannot be too much 
insisted upon, and it alone corrects many cases of con- 
stipation. 

MASSAGE 

If dietetic and hygienic measures are inadequate, there 
are still some other resources within the scope of domestic 
practice. The first to be mentioned is massage of the abdo- 
men. The only objection to it arises from the ticklishness 
of some children, but if the masseuse, mother or nurse, re- 
members that the pressure of the fingers is to be made as 
if to reach something beyond the skin the tickling does not 
follow as it does from too light a touch. It is best that the 
massage should not be applied while the stomach is quite 
full. The following is a simple method which works very 
well : Slightly anoint the fingers of one hand with vaseline 
or some other lubricant to protect the skin from irritation. 



DISORDERS ASSOCIATED WITH IMPROPER FEEDING 131 

Beginning rather low down on the right side of the abdomen 
with the tips of the fingers make little circular movements, 
advancing upward to the neighborhood of the ribs, then 
cross to the opposite ribs and then down upon the left side 
toward the groin. After a moment's rest, the performance 
is repeated, and so on for a number of minutes, say five, the 
time being increased if the shorter sittings are ineffectual, 
and two sittings a day may be given if necessary. If the 
operator pictures to herself an imaginary body within the 
bo"wel which she desires to coax along from the right flank up 
and across and do^vn through the course of the large intestine 
she will pretty certainly hit upon the correct manipulations. 
Similar ones may, if necessary, be applied to the whole 
abdomen. 

AYhen other devices become necessary, there lies a choice 
between laxative medicines, suppositories, and enemata. As 
to which is the most preferable— i. e., which has most ad- 
vantages and fewest disadvantages— all are not agreed, nor 
is it probable that the answer should be the same for all 
eases. The writer's preferences on the whole are in this 
order: suppositories, enemata, and laxatives. 

SUPPOSITORIES 

In many cases the suppository must act merely by exciting a 
reflex action in the bowel or by bringing the child 's attention 
to the desired act. For we often find that the simple intro- 
duction of an oiled syringe-nozzle or an oiled paper lamp- 
lighter is promptly followed by an evacuation. Among 
popular remedies we find simple suppositories shaped of mo- 
lasses candy and soap. The latter has a decidedly stimu- 
lating action, and its prolonged use is said often to cause 
local irritation. Probably the kind of soap has much to do 
with this, but in any case where the oiled soap-cone is used 
signs of local trouble should be watched for. Glycerin sup- 
positories are much used, and often for a long time without 
harm, but the same watchfulness should be given to them, as 



132 THE CENTURY BOOK FOR MOTHERS 

glycerin is not a bland substance to all persons. Medicated 
suppositories should not be used without specific medical 
advice, and it is unfortunately true that some suppositories, 
sold under very innocent sounding names, often produce the 
evidences of strong medication upon the system. 

ENEMATA AND LAXATIVE MEDICINES 

The occasional use of the enema belongs properly to the 
nursery. Its prolonged use should not be adopted without 
medical advice. The same is still more true of laxative 
medicines. 

It is to be borne in mind that medicinal treatment for 
habitual constipation is not to be adopted until a thorough 
and careful attempt to correct the difficulty by diet and 
hygiene has been made and failed. 

VARIETIES OF DIARRHOEA 

DiARRHCEA, as the word is here used, means any disorder 
in which the evacuations from the bowels are increased in 
number and diminished in solidity. It is not true that all 
forms of diarrhoea are due to faulty feeding, but for the 
practical purposes of the nursery it is so nearly true that it 
may be so assumed. Different kinds of diarrhoea are de- 
scribed and are classified according to the views of authors. 
Those most commonly recognized are : 

Simple diarrhoea, meaning a slight, brief diarrhoea, gener- 
ally due to undigested food, occasionally to chilling or to 
heat and, but rarely, to the process of teething. 

The summer diarrhcea, now believed to be usually due to 
some bacterial cause and based upon some preceding errors 
in diet. 

The inflammatory diarrhoea, probably due to similar 
causes, but with more pronounced manifestations, such as 
mucus and blood in the stools. These last-named peculi- 
arities of the stool usually are considered to constitute 
dysentery. 



DISORDERS ASSOCIATED WITH IMPROPER FEEDING 133 

The name cholera infantum, is often used to characterize 
the last-mentioned type of diarrhoea. It is a misuse of the 
name, and often gives undue alarm. The true cholera in- 
fantum is a rather rare disease, characterized by symptoms 
very similar to those of real cholera— namely, very watery, 
colorless discharges, usually vomiting, fever, and very rapid 
exhaustion. It is probably dependent upon some special 
poison, which is most likely one generated in bad milk. As 
the destructiveness of this type of diarrhoea is well kno^^^l, 
it is a pity to give its alarming name to either summer diar- 
rhoea or inflammatory diarrhoea, as is often done. 

RULES FOR ALL CASES OF DIARRHOEA 

For the physician the discussion of the various diarrhoeal 
diseases and their management is a long one. But for the 
nursery guardian the rules are few and simple. It is safe 
to assume that some error of feeding has occurred. Either 
the cow's milk as given has for some reason not been what it 
should have been, or other improper food has been given, 
or more food than the child could digest, or it has been so 
frequently given that the digestive organs have had no rest, 
or the child was not in a condition to digest Avhat ordi- 
narily would have been proper, and so on. Therefore it is 
advisable 

First of all, always to clear out the digestive tract to re- 
move improper or fermenting substances likely to be there. 
Despite its unpleasantness, castor-oil maintains its place as 
the most desirable remed}^ If it is retained, its action is more 
satisfactory than that of any other drug. If there is vomit- 
ing or much nausea it may be better to facilitate the clear- 
ing of the stomach by giving large draughts of warm water, 
which will be pretty certainly rejected. Calomel is a cathar- 
tic which has the advantages of helping to allay the stomach 
disturbance, as well as to disinfect the canal. 

Second, if the cathartic does not put an end to the diar- 
rhoea it is wise to ask medical advice. The same is true if 



134 THE CENTURY BOOK FOR MOTHERS 

vomiting continues after the stomach has been cleaned out, 
as vomiting and fever may be a symptom of many disorders 
besides those of the digestive organs. 

Third, the child is to be kept quiet and recumbent, best 
in bed. 

Fourth, the digestive tract should be given as complete a 
rest as possible. Suckled children rarely have diarrhoea so 
long as they have no other nourishment. Children partly 
or wholly artificially fed, however, seem liable to these dis- 
orders in a general way in proportion as their diet departs 
from the natural standard. Therefore all solid food and all 
cow's milk should be stopped. Water (and in nursery sick- 
ness water means that which has been boiled and cooled) 
maj^ be given in small quantities, and more freely if the 
stomach is quiet. If food is required, rennet whey, with 
or without wine, and white-of-egg water have both the 
indorsement of tradition. The egg mixture is made from 
the white of one egg, half a pint of water, seasoned slightly 
with salt. The white sugar formerly added is better 
omitted. It is usual to add brandy, say a teaspoonful. 
This mixture is given by spoonfuls. If much is given to a 
young child the amount of brandy need not be so great in 
proportion. 

These simple measures are applicable to all the varieties 
of diarrhoea at the beginning. They may cure the malady, 
and in any case what has been done will be of assistance to 
the physician if his services are required. 

STOMACH INDIGESTION AND COLIC 

The same general rules are applicable to the treatment of 
stomach indigestion. If the trouble be but recent, unloading 
the stomach and bowels, rest of the body, and especially of 
the digestive organs usually restore the normal condition in 
a few days. 

One other ailment of the digestion, more troublesome than 
dangerous, but causing in the aggregate a good deal of suf- 



DISORDERS ASSOCIATED WITH IMPROPER FEEDING 135 

fering is intestinal colic, usually due to flatulence and popu- 
larly called wind-colic. It is found chiefly in the earlier 
months of infancy, both in suckled and fed children, but is 
nevertheless usually due to indigestion, and this to some 
disproportion between the food and the indi^^dual digestive 
powers. The picture of the contorted face, the spasmodic 
cry of pain, the hard abdomen, and the drawn-up limbs is 
familiar to most nurses. As the gas causing the pain is in 
the bowels it is much more promptly expelled if, instead of 
giving medicine (carminative teas, etc.), enemas to start in- 
testinal action are used. A few ounces — three or four — are 
sufficient for an enema in young infants. Lukewarm water 
is useful. The writer has found a weak tea of catnip or 
mint leaves, especially the former, given warm, more efficient 
when used as an enema than when given by mouth. A small 
amount of glycerin is a very efficient addition to the water 
of an enema : for four ounces, from fifteen drops upward 
may be added, according to the age of the infant. Hot ap- 
plications, preferably dry, are also useful. Friction or gen- 
tle manipulations of the bowels with the hand seem to stimu- 
late the intestine to expel the gas. 

If the infant be artificially fed the habit of colic may be 
corrected by more perfectly adjusting the food to the diges- 
tion. If the child be suckled this is more difficult, often 
impracticable. 



THE EVIDENCES OF ILLNESS 

IT is not necessary, even if it were desirable, that the 
mother or nurse should be able to make a diagnosis of 
the nature of any disease that a child may have; but it is 
very desirable that she should be able to recognize the symp- 
toms of illness. These may be so direct and simple that 
they indicate the disease. At all events, they should con- 
vej^ to the mother the information that the child is not well 
and in need of help, either hers or that of a physician. If 
she has familiarized herself with the signs of health she will 
easily recognize departures from them. Below are some of 
the commoner ways in which a child manifests that it is not 
well, and may possibly indicate its malady. 

GENERAL BEHAVIOR 

Deportment. The usual expression of discomfort is rest- 
lessness and fretfulness. Sleep is disturbed, the quiet baby 
is no longer so, but desires attention, wants to be taken up, or 
in other similar ways shows that it is not at ease. Less fre- 
quently, children in illness, especially if the temperature be 
raised, become unusually heavy and drowsy. 

Posture may vary somewhat in accordance wdth the just 
mentioned nervous states— that is to say, the restless child 
constantly changes its position, while the heavy one may 
lie perfectly quiet in one position, without much apparent 
preference as to what that particular one shall be. Special 
postures often are indications of particular conditions. 

136 



THE EVIDENCES OF ILLNESS 137 

Thus, the head may be bent backward and the neck stiffened, 
or there may be a boring motion of the head with some 
inflammation of the brain envelops (meningitis). If there 
is labored breathing from any cause the child may be un- 
willing to lie down, and require to be held or propped up. 
If there be pain in the abdomen the limbs are generally 
drawn up. JVIany postures are assumed to avoid exciting 
local tenderness or pain. 

Pain is expressed not only by cries but sometimes by ex- 
pressive gestures. Often the child's hand is put to the seat 
or the pain. 

Of local symptoms a few may be mentioned. 



THE HEAD, FACE, AND EYES 

The Head. Unusual shapes are gradually assumed in rick- 
ets (see p. 125), and in hydrocephalus, or chronic ''water 
on the brain." But as evidence of acute illness, heat of 
the head, signs of headache, as shown by putting hands to 
the head; unwillingness to move the head quickly, may be 
instanced. If the child has the fontanelle still unclosed its 
throbbing may be used for counting the pulse more easily 
than at the wrist. It can be done by sight. If the head be 
fuller of blood than usual, as is sometimes the case in fever, 
the fontanelle may be prominent. In wasting diseases or 
with very poor nutrition it may be sunken. 

The expression of the countenance as a whole tells not a 
great deal, except the difference between comfort and dis- 
comfort, but the various parts of the face often are expres- 
sive. Thus : 

The eyes are frequently suffused in illness, especially at 
the approach of cold beginning as nasal catarrh ("cold in 
the head") or of measles. If the eye itself be inflamed or 
sensitive it may be red or the child may avoid the light by 
closing them or by turning the head. In disease the pupils 
may be enlarged or contracted, but rather as evidence of 
existing mischief than as a forerunner of trouble. A for- 



138 THE CENTURY BOOK FOR MOTHERS 

eign body in the eye generally excites spasm of the eyelids 
and a flow of tears. Sleeping with half-closed eyes, if seen 
in illness, generally denotes depression. 

The sides of the nostrils are seen to move in respiration in 
conditions of labored breathing, especially pneumonia. 

SIGNS ABOUT THE MOUTH 

The mouth gives a good many indications. If it be kept 
open, especially in sleep, it probably means obstruction to 
the ingress of air through the nose. Enlarged tonsils and, 
above all, the pressure of an adenoid growth in the pharynx 
may be suspected if the open mouth is habitual. If it is an 
accompaniment of fever, more likely it signifies tonsilitis. 
Children often put their hands into their mouths when the 
gums are tender or when the tonsils are painful, as well as 
when they are hungry. Eruptions are seen about the lips, 
especially at the corners of the mouth, in various ailments. 
The breath gives notice by its bad odor of disordered stom- 
ach, as well as of diseases of the nasal and pharyngeal mucous 
membrane. The gums are swollen with teething, swollen and 
easy to bleed in infantile scurvy. The upper surface of the 
tongue presents a great variety of coatings in various disor- 
ders. That which is of most importance in the nursery is the 
whitish or grayish overlaying (not the whitish tongue of the 
very young baby) which exists in a multitude of disturbed 
conditions, but which is generally considered as indicating 
some stomachic derangement, most likely due to improper 
feeding. Interrupted drinking or suckling or difficulty in 
swallowing suggests some obstruction to a free supply of air, 
such as collections in the nostrils, swollen tonsils or adenoids, 
or even some pulmonary troubles. 

THROAT TROUBLES 

The throat and fauces can be readily examined by plac- 
ing the child upon the lap of another person in such a way 
that it faces the light. The child's head is held. The ob- 



THE EVIDENCES OF ILLNESS 139 

server then depresses its chin to open its mouth, and if the 
child cries no depression of the tongue is usually necessary. 
If it does not cry, the tongue may be gently and quickly 
depressed by some small, smooth, flat implement ; the smooth 
handle of a teaspoon is the traditional one. A single glance, 
if fortunate, shows if the tonsils be swollen, if they have 
any white spots or patches upon them or on other parts 
of the throat. It is not easy to describe the differences 
between the spots of the ordinary ' ' follicular tonsilitis ' ' and 
the patches of the diphtheritic variety. In fact, the bac- 
teriological stud}^ of such matters has to a very great degree 
broken down the distinctions formerly made. So far as 
anything can be stated, it is this: that spots on the tonsils 
alone which show no tendency to spread or to run together 
are probably not diphtheritic. Those which do spread or 
unite, and spots on the palate, in the pharynx ("back of the 
throat"), or in the nose probably are diphtheritic. But 
the distinction is not to be certainly made, even by a physi- 
cian, without microscopic evidence. Hence, any sore throat 
should be isolated, and if any patches or spots are seen it 
is better to have a physician's opinion. "Sore throats" 
are not to be slightingly treated, since there is good reason 
to think that— aside from diphtheria— they are the infective 
starting-point for enlarged glands, rheumatism, and other 
constitutional disorders, not to mention nearly all ear 
troubles. 

THE VOICE 

The voice and cry vary with the disturbance. The tired 
"worry" of a sleepy child is sometimes heard in illness. 
The explosive cries of anger and fright are not evidence of 
illness. The hoarse note heard in both cry and cough, the 
latter resembling a bark, shows laryngeal inflammation— 
that is, croup. In obstructive croup the sound is much 
lessened. When the nose is obstructed the note of the cry 
is modified, as would be the voice of an adult. The loud 
cry of pain is pretty easily recognized; it is prolonged or 



140 THE CENTURY BOOK FOR MOTHERS 

spasmodic, in harmony with the pain, the tormenting pain 
of earache, for instance, giving rise to a prolonged cry, a 
colic usually to one which is interrupted and renewed. 

THE EARS 

The ears give notice only of troubles connected with them- 
selves, and then through tenderness of the external ear when 
touched ; but it is well to discover, by touching or lightly tap- 
ping the bone behind the ear, if there be tenderness there, 
a.s such a symptom calls for prompt attention. Discharge 
from the ear is evidence of disease within, a condition to 
which too little attention is often given. 

BREATHING 

The warnings from the chest usually come through altered 
breathing or through coughing. The respiration of an in- 
fant is much faster in health than that of an adult, and is 
somewhat less regular. The respiration is hurried, with 
a rise in temperature, and roughly in proportion to the de- 
gree of rise, the pulse usually rising also symmetrically. 
In pulmonary inflammation the rate of respiration often, 
but not always, rises out of proportion to the pulse-rate and 
the fever. Slowing of respirations below the normal ordi- 
narily may mean some brain disturbance, such as the men- 
ingitis caused by tubercle or poisoning from opium. Very 
disordered rhythm of breathing, rising and falling, are no- 
ticed in some brain troubles. Difficulty of breathing, such, 
for instance, as is caused by obstructions in the windpipe, 
by diphtheritic croup, produce the breathing known as 
"labored," in which all the accessory muscles that can help 
respiration are called into service. 

VARIOUS COUGHS 

Coughs have a good deal of character. The resounding 
metallic bark of common "spasmodic" croup has just been 



THE EVIDENCES OF ILLNESS 141 

alluded to. No Avarning need be attached to it, for it com- 
pels attention. The smothered, hoarse cough of laryngeal 
obstruction is really more alarming to the physician. The 
cough of throat irritation is usually short and teasing. That 
of bronchitis is pretty frequent, and not usually very tight, 
while if the chest be sore there is apt to be a little cry with 
or after it. The cough of pneumonia is tighter, seems to 
be, and probably is, suppressed on account of pain, and the 
child has no breath to waste in crjdng. In fact, it is sur- 
prising to see to what an extent a child ^^ith this disease will 
sometimes refrain from crying and eating, apparently to save 
breath. The cough of influenza, when characteristic, is per- 
sistent, pestilent, and wearing, often recalling that of whoop- 
ing-cough. The cough of this latter disease is so characteris- 
tic that without its peculiar "whoop" the diagnosis may 
remain uncertain. The patient begins with a cough, a little 
spasmodic, which is repeated more and more rapidly, without 
proper inspirations, until the stomach is emptied by vomit- 
ing or the paroxysm ends with a long crowing inspiration, 
which is the ''whoop." The performance may then be re- 
peated. 

VOMITING 

The stomach empties itself much more easily in infancy 
than later. The overfull suckling regurgitates its sur- 
plus without an effort, and this return is not a sign of 
illness. Real vomiting, however, is often seen as evidence 
of stomach indigestion (tough curds, etc.), as well as of 
other stomach and bowel troubles. It is a frequent initial 
symptom of some of the eruptive fevers, notably scarlatina, 
also of pneumonia and of malarial fever. In the latter two 
disorders initial chills are rarely seen in young children, 
while vomiting or convulsion instead is not rare. Peculiar 
types of vomiting are seen in special diseases, such, for in- 
stance, as the so-called ''projectile" vomiting associated with 
some brain disorders, the matter being suddenly and vio- 
lently ejected; vomiting often attends the rally from the 



142 THE CENTURY BOOK FOR MOTHERS 

stunned condition (concussion) arising from a blow or fall 
upon the head. The vomiting of whooping-cough seems to 
be merely a mechanical result of the violence of the 
paroxysm. 

The abdomen will help to make a diagnosis in case of 
colic. It is then usually distended, hard, and, if tapped 
upon, resonant. The retracted abdomen of some brain trou- 
bles is rarely an early symptom. 

THE URINE AND BOWEL DISCHARGES 

The urine, which in infancy is pale, clear, and of little 
odor, may in illness become scanty, darker, and sometimes 
have fine reddish grains, which can be seen. When these 
are very minute they may be known only by the stain on 
the diaper. Granules large enough to be seen may cause 
pain in passing. Medicines may stain the urine. Santon- 
ine, an ingredient of some worm lozenges, gives it a saffron 
color, which may stain the napkins. Children who eat as- 
paragus pass urine having the familiar offensive odor of the 
eliminated asparagin. 

The stools are, in a healthy infant, characteristically yel- 
low, the depth of the tint bearing some relation to the 
strength of the food. The stools often undergo a change 
of color to green soon after they are passed, sometimes 
without any derangement of health. Stools persistently 
green when passed generally denote intestinal disturbance. 
Lack of bile in the movements gives a gray color, often 
called "clay-colored," and this may be even chalky. Some 
medicines color the stools. Bismuth is the most striking in 
its effect, as its stain is an olive-green, which may be bluish 
or even nearly black. Iron also blackens stools. Any con- 
siderable blood in a movement coming from some distance 
up the canal may make it black and sticky in consistency. 
Curds in the stool denote indigestion. Mucus (which in 
health is incorporated with the fecal matter) is evident and 
often streaked with blood in inflammations of the intestinal 
eanal (inflammatory diarrhoea). 



THE EVIDENCES OF ILLNESS 143 



FEVERS 



The sJcin gives indications of fever by its heat and dry- 
ness. It will often, if examined carefully, show various 
eruptions, which may be those of the special eruptive fevers, 
or may be some of the various skin manifestations indicative 
of digestive or nutritional disturbances. The former erup- 
tions will be alluded" to in connection with symptoms of 
these fevers. 

Temperature. Since the introduction of the fever ther- 
mometer it is no longer necessary to judge of the degree of 
fever by the touch. The latter will be deceptive if the skin 
of the child be, as may happen, moist as well as hot, or if 
the hand of the mother be either unusually hot or cold from 
anxiety. A thermometer can now be had for a dollar, or 
a little more, which will register in a minute or two. The 
temperature is best taken in the rectum. The thermometer 
is first washed and dried, the registering index shaken down 
below the marked normal point, the bulb end anointed with 
vaseline or some other unguent, and then gently slipped 
into the bowel about an inch. After a minute or two, or 
longer if the instrument be a slow one, it is gently removed 
and the temperature read from the top of the registering 
index. The bowel gives the full heat of the body more com- 
pletely than the mouth, armpit, or groin. The instrument is 
again cleaned and put away. 

The temperature is not a fixed indication of degree of 
illness. Its value must be taken in connection with many 
other things. A temperature which would be trivial from 
one cause may give the physician much anxiety if from 
another. It seems, therefore, unwise to set up any figure 
as the mark of great danger. It may, however, be fairly 
said that temperatures from 100° P. to 102.5° or 103° consti- 
tute what is usually called moderate fever; from 103° to 
105° high fever; above that point very high or exceptional 
fever. The height of the fever, the disease being the same, 
corresponds fairly well with the severity of the attack. 
Probably of more importance than the point marked at any 



144 THE CENTURY BOOK FOE MOTHERS 

one time is the duration of the fever. The indication 
of fever, if of more than very moderate amount, is to 
call for medical help, unless the temperature promptly 
yields. 

Given a fever of the range denominated moderate or high, 
its meaning may be often guessed from the attendant symp- 
toms. Thus, if with smart fever the child cries much and 
puts its hand to its head or ear the trouble is very likely 
in the latter, especially if throat trouble has preceded. Fever 
with the signs of sore throat described make tonsilitis prob- 
able. Fever with cough suggests bronchitis or pneumonia, 
and so on. 



SYMPTOMS OF CONTAGIOUS DISEASES 

While, as already said, it is not the purpose of this book 
to enable the mother to recognize and treat diseases, it is 
desirable that she should have knowledge of the symptoms 
which are usual in the beginning of contagious diseases, 
especially of the eruptive fevers, since with these the patient 
needs to be promptly isolated from other children. It can 
hardly be too much insisted on that every sick child should 
be as far as possible isolated, not only for its own advantage, 
but, until it is positively known that its disease is not con- 
tagious, for the safety of others. 

These contagious disorders have a number of peculiarities 
in common, besides the fact that the temperature is elevated. 
First they have a period of incuhation— that is, a period 
between the exposure which is the source of infection and 
the very first symptom. This period is more variable in 
some diseases than in others, and some variations exist for 
all. Thus, it is for 

Scarlatina, from one day to three weeks, but most cases 
appear within a week, a majority within four days after 
exposure. 

Measles, usually between eleven and fourteen days, but 
much wider variations in both directions exist. 



THE EVIDENCES OF ILLNESS 145 

German measles has the same wide variation, but most 
cases develop between the eighth and the sixteenth day. 

WJwoping-cough, probably betAveen one and two weeks. 
It comes on so gradually that it is difficult to be sure of its 
exact beginning. 

Mumps, usually from two and a half to three weeks. 

Chicken-pox, usually from fourteen to sixteen days. 

Varioloid (that is, small-pox modified by earlier vaccina- 
tion), ten to fourteen days. 

Small-pox, usually twelve days. Vaccination, two to 
four days, commonly four before there are really noticeable 
effects. 

A knowledge of these periods is helpful, in that if they 
pass, after known exposure, without manifestations of dis- 
ease, it may be considered that contagion has probably not 
taken place. 

THE INVASION PERIOD 

Secondly, these diseases have a period of invasion, in popu- 
lar language, "when children are coming down with" this or 
that disease. The invasion of an ordinary case of scarlatina 
is usually marked by abrupt rise of fever, vomiting, occa- 
sionally a convulsion, sore throat, which looks red, and the 
eruption, following in from twelve to thirty-six hours. Mea- 
sles begins with irritation of the eyes, sneezing, running from 
the nose, and a very irritating cough. Certain spots in the 
mouth are thought to indicate measles, but they are not easily 
recognized without training. The eruption comes after 
from two to four days. Measles is one of the most con- 
tagious of diseases, and may be communicated from the 
beginning of the symptoms. The fever of measles gener- 
ally rises rather gradually until the rash is well started, 
then gradually declines. 

German mea.sles has a very brief invasion— a few hours— 
and often the eruption is the first thing noticed. Other 
symptoms, if any, are usually similar to those of measles, but 
much less marked. 
10 



146 THE CENTURY BOOK FOR MOTHERS 

Chicken-pox has little fever, the eruption appearing within 
twenty- four hours. 

Mumps has but slight fever, and the local symptoms are 
such that they can hardly be mistaken, especially if the 
disease is known to be prevalent. 

CHARACTERISTIC ERUPTIONS 

The eruptions are for the most part distinctive. That of 
scarlatina is made up of such minute red points as to ap- 
pear an even red. It first appears on the neck and chest. 
If looked for, it, or something very like it, can be often seen in 
the throat before it appears upon the skin. Once it begins 
upon the skin it spreads gradually over the whole body, dis- 
appearing in the same order. It continues from three to 
seven days. The desquamation or '' peeling" begins soon 
after the rash has gone. The epidermis often falls off in large 
pieces. It may last many weeks, even two months. The 
time of greatest communicability is during the periods of 
active eruption and the desquamation. So long as the latter 
continues anywhere the patient is a source of contagion. 
Mild cases are often very dangerous in this regard, as they 
are not always carefully watched. 

The eruption of measles is much darker in color, is made 
up of dark red or purplish spots, sometimes raised slightly. 
These spots are usually gathered in small patches, often 
described as crescentic, although not very strictly of that 
shape, spaces of clear skin intervening between them. In 
very profuse eruptions the patches sometimes run together. 
The eruption usually is first found, if looked for, behind the 
ears, but oftener is first noticed on the face and forehead. It 
spreads during two, three, or more days over the body, fades 
in the same order, lasts usually from four to six days, and 
desquamates in fine pieces. The eruption of German mea- 
sles appears first upon the face ; sometimes it may be found 
still earlier on the roof of the mouth. Sometimes it spreads 
like the other eruptions, sometimes seems to come all at 



THE EVIDENCES OF ILLNESS 147 

once. It is remarkable for its variability in appearance. 
More commonly it is a good deal like the eruption of measles, 
but appears in larger and more solid blotches of spots. 
Again, it may quite closely resemble that of scarlatina. It 
is sometimes quite difficult to discriminate, and the disease 
is perhaps more important from the trouble it creates 
through mistakes than from its own gravity. The rash usu- 
ally lasts two or three days. It has been thought that more 
than one disease may be really included in the name of Ger- 
man measles. Chicken-pox has an eruption of distinct, scat- 
tered, slightly raised, flattened spots, many of which progress 
to the formation of blisters (vesicles). These dry into crusts, 
beginning in the middle of the vesicles. The eruption ap- 
pears in crops, so that the various stages may be seen to- 
gether after a few days. Whooping-cough has no eruption, 
and, as has been said, its one certain symptom is the peculiar 
cough. 

PERIODS OF ISOLATION 

The quarantine period of these diseases differs. Scarla- 
tinal patients must be isolated as long as any desquamation 
is observed anywhere. It lingers longest on the hands and 
feet. The poison clings in a remarkable manner to the sick- 
room and to articles in it. Hence the need of very thorough 
disinfection. Measles generally has completely gone by the 
end of four weeks, and the contagion rarely lingers in 
articles about the patient. It seems to be to a great degree 
personal. 

German measles is a disease of such ordinarily mild be- 
havior that, except in institutions, quarantine is rather 
lax regarding it, provided the diagnosis of the disease is 
sure. 

Whooping-cough is, like measles, very contagious, and, 
like it, communicable from the very beginning of symptoms. 
Its characteristic symptom— the whoop— is so long in appear- 
ing that the sufferers are usually allowed to go about a long 
time after the disease is communicable. How long it is 



148 THE CENTURY BOOK FOR MOTHERS 

communicable is not well settled. Probably it is so for three 
months on the average, and the quarantine should be contin- 
ued for some time, a week or two certainly, after the patient 
has ceased to whoop. 

Mumps also is thought to be contagious for a considerable 
time. 



XI 
DOMESTIC TREATMENT OF ILLNESS 

THE domestic treatment of illness, if it be wise, is little 
more than skilful nursing. As the mother gains expe- 
rience, she may venture upon some simple medications. As 
the skilled physician of to-day usually relies more and more 
upon hygiene and the application of physiological know- 
ledge, and less and less upon medication, so wise domestic 
medicine will have little of dosing in it. It is assumed that 
if a child be really ill a physician will be called. Often it 
will prove that if he had been called early a single visit would 
have been enough; bad domestic medicine leads to his being 
obliged to pay many. 

The mother, if she sees the evidence of some illness, may 
think it unnecessary to send for a physician, and may be 
quite right in so thinking. But she may wish to do some- 
thing for the child's relief. Her first endeavor will be to 
try to learn what is the trouble wdth the child. She may 
know of exposures, fatigues, errors of diet, or even of con- 
tagious maladies to which it may have been exposed. If 
she has any idea of the nature of the malady, or if she can 
note only symptoms, her next thought should be, What am 
I trying to do? The answer should be, "I am trying to 
relieve this or that symptom," in which case she is likely to 
do no harm, at the least. This is emphasized because in 
practice the physician too often can see no reason for the 
treatment which has been given before he arrives, except a 
nervous, anxious desire to ''do something." If, then, the 
mother asks herself. Will this remedy relieve the symptom? 

149 



150 THE CENTURY BOOK FOR MOTHERS 

will its employment throw any obstacle in the way of the 
proper treatment of the case if further treatment be neces- 
sary? she has a fair chance to cure the child herself, and, 
if not, she has helped the physician to do it. 

PRECAUTIONARY MEASURES 

First, she may put the child to bed. • This alone is a reme- 
dial measure. The mere undressing of the child may reveal 
some previously unnoticed symptom. The putting of the 
child into bed takes it off a drafty floor, and removes the dis- 
comforts of clothing, and recumbency relieves many an irri- 
tation due to activity. At the beginning of ' ' a cold " or of a 
diarrhoea it may be of considerable service. A child who, i£ 
allowed to play around half sick till bedtime, would have a 
feverish night may have a far more comfortable one if it has 
been put to bed as early as it is discovered to be ailing. The 
infant practically is abed most of the time, and this sug- 
gestion is not very useful at its early age, except so far as 
meaning that the little one is to be put into the more com- 
fortable night garments. Do not burden it with unnecessary 
coverings. 

It is sometimes objected that the child does not like to go 
to bed. This brings up one of the most important matters 
in the care of sick children— namely, the habit of obedience. 
The child Avho has been taught to obey and obey promptly 
rarely rebels in illness. Habitual wilfulness balks all en- 
deavors for the child's benefit. Slight illnesses become con- 
siderable ones, severe ones become perilous. It is no exag- 
geration to say that lives are sometimes lost through the 
resistance that a wilful child may make. It not only fa- 
tigues the attendants, but wears out its own strength. It 
is well known that such children often obey a trained nurse 
better than a member of the family, and it is true, however 
regrettable, that in some nurseries there is no difficulty if 
the physician has no helper but the ordinary nursery- 
maid, while if the mother or the father be present, proper 



DOMESTIC TREATMENT OF ILLNESS 151 

examination or treatment of the little patients is nearly 
impossible. 

THE WARM BATH 

Baths are among the most efficient remedial agencies at our 
command, and are accessible to nearly every one. Baths 
are named according to temperature, different writers classi- 
fying them in a slightly different way. Only three baths 
have a place in illness without medical direction— the tepid 
bath, 85° F. to 91° F. ; the icann bath, 91° F. to blood-heat, 
98.6° F. ; the hot bath, any temperature above blood-heat. 
If it be a bath for immersion of the Avhole body, 104° F. or 
105° F. will usually be the limit of tolerance. It is doubt- 
ful if there is any disease at the beginning of which a warm 
bath may not be safely given to a child previously well. 
In almost any state of irritation it soothes the nervous system, 
as well as the skin. It is also to be remembered that al- 
though its temperature is very nearly that of the body in 
health, if there be four to six degrees of fever the bath will 
be quite a little below that abnormal temperature, and tem- 
porarily will diminish it, with corresponding diminution of 
discomfort. It is this warm bath which is most commonly 
and judiciously used in illness. It will be noticed that its 
application has been just now restricted to the beginning of 
illness. This is because there are some diseases, especially 
those of the chest, in the course of which baths should not 
be given without specific directions, and because in the course 
of eruptive fevers, in which they are often very valuable, 
there are conditions in which they must be given with 
caution. 

The hot bath is very stimulating, is useful in case of 
chill or chilling, and is often applied to hasten the appear- 
ance of an eruption which is believed to be imminent but de- 
layed. It is of more limited use than the warm bath, and 
is to be employed with more caution. The tepid bath is 
used when a more distinct depression of temperature is 
desired than will be produced by a warm bath. 



152 THE CENTURY BOOK FOR MOTHERS 

MEDICATED BATHS 

Baths may be medicated in some Avays for especial pur- 
poses. Thus, for certain irritations of the skin an alkaline 
bath may be desirable. Such a condition is seen in the well- 
known prickly-heat of summer, or in nettle-rash or hives. 
If to a warm or tepid bath enough soda— either the car- 
bonate, "washing-soda," or the bicarbonate, ''baking-soda" 
—is added to give the water a slightly slippery feeling be- 
tween the fingers the bath is more likely to allay the itching 
than a simple bath would be. 

Similarly, for some skin irritations, as in some cases of ec- 
zema, a hran hath has a beneficial influence. It is made by 
boiling a bag of bran and adding the water in Avhich it has 
been boiled to the bath, or by squeezing the bag of bran in 
the hot water in the bath-tub, which will meantime cool 
sufficiently for use. A similar effect can be obtained by 
adding starch to the bath, or to the alkaline bath just men- 
tioned. 

Salt added to the bath increases its stimulating power, 
making it comparable to sea bathing. The salt baths are 
chiefly useful in debility, and may be used for children too 
young or too feeble for sea bathing, or at seasons when and 
in places where the latter is not obtainable. 

Mustard is a still more stimulating addition to the bath. 
Unlike salt, its application is in acute conditions, and only 
for a short time. It must be used very cautiously in a gen- 
eral bath, for fear of too great irritation of the tender skin 
of childhood. Its greatest use is in a foot-bath or hip-bath, 
often used to relieve symptoms of congestion in the head or 
chest, as in the beginning of a "cold." 

Disinfectants may be added to baths when it is thought 
that contagion lingers about the skin. As this most com- 
monly occurs after contagious eruptive diseases it is prob- 
able that the physician will direct the most desirable form 
of bath. Many of the most efficient antiseptics are not quite 
safe for indiscriminate use in the bath. A salt bath of good 



DOMESTIC TREATMENT OF ILLNESS 15 3 

strength, say a pound of salt to eight gallons of water, is 
itself disinfectant to some degree. The skin, after drying, 
can be rnbbed with alcohol, which is a good antiseptic. 
Among safe disinfectant drugs, boric acid and salicylic acid 
may be mentioned, but, owing to their cost, they would 
better be used in a sponge-bath, after a thorough cleansing 
in the ordinary bath. 



HOW TO GIVE BATHS 

A FEW words may be said about methods in giving baths. 
A child's ordinary bath-tub may be used, but if the bath be 
much hotter or cooler than the child is used to, especially if 
the tub be of metal, it is better to place in the tub a sheet or 
large towel to prevent the body's touching the tub and get- 
ting a shock. If a warm bath— and still more if a hot bath- 
has been given, the child should be lifted immediately into a 
blanket or warmed sheet, and rolled up and not dressed until 
the skin is dry and the change a little recovered from. 

If it be desired to give a tepid or even cooler bath, and 
shock be feared, or the child be timid or excitable, the object 
may be accomplished by what is known as the "graduated" 
bath— that is, one of gradually changing temperature. If 
the ordinary set tub be used, a tube of rubber can be first 
adjusted to the inlet of the cold water. This is hidden by 
the bath-sheet. A warm bath is drawn, and when the child 
has been in it a minute or two the cold tap is very slightly 
opened and the water allowed to run very slowly, until the 
desired temperature of the bath is shown by the bath-ther- 
mom.eter. 

The duration of a bath varies with the temperature. A 
warm bath should ordinarily not be continued beyond 
ten, or at most fifteen, minutes. A hot bath must be very 
brief. It is better to repeat the immersion if necessary, 
after a little while, than to make the first one unduly 
long. The same is equally, if not more, true of cooler 
baths. 



154 THE CENTURY BOOK FOR MOTHERS 

SPONGE-BATHS 

When cool or cold baths seem called for it is better, in the 
absence of medical advice, to give them in the form of 
sponge-baths. The child, lying upon a blanket or bathing- 
sheet, and lightly covered, can be sponged part by part 
until the desired alleviation of the discomfort or symptom 
is gained. Exact indications for the use of hot or cool baths 
cannot be well given, as they depend upon states of the 
pulse and circulation not appreciated without training. In 
a general way, it may be said if the child is weak or depressed 
give only the warm bath. 

VAPOR-BATHS 

If, on the other hand, it be desired to excite perspiration 
rapidly and profusely, a vapor-hath A^dll be an efficient 
method. If there be a croup-kettle obtainable, it is the most 
convenient way of making steam. In its absence, steam 
from a tea-kettle may be made use of. In either case the 
bed-clothing is to be raised tentwise, either by hoops beneath 
or a cord from above, and the vapor introduced underneath 
them by a pipe. For a child able to sit up the ancient 
method of a chair sweat may be employed. The child was 
placed in a chair, an ordinary wooden-bottomed kitchen 
chair or a cane-seated one; a blanket was drawn about the 
child and chair, inclosing both as in a tent, the head alone 
appearing through the top. Upon a heated brick or stone, 
placed in a basin under the chair, hot Avater was allowed to 
slowly drip. The heat of the stone or brick vaporized the 
already heated water. In the same way a hot-air bath may 
be extemporized, the heat being obtained from heated stones 
as before, from a vessel of hot water, or even, with proper 
precautions, by means of burning alcohol— the traditional 
"rum-sweat" of New England. The hot-air bath is even 
more efficient than the vapor in inducing perspiration. It 
can be very easily given in bed by using an elbow of metal 



DOMESTIC TREATMENT OF ILLNESS 155 

pipe (stovepipe, for instance) . One arm goes under the ele- 
vated bed-clothes as before. The other extends down toward 
the floor. Under its open end a lamp, preferably an alcohol 
lamp, is placed. The hot air rises into the bed. 

COLD COMPRESSES 

If it be desired to reduce locally the heat of any part, the 
usual resources are cold compresses or ice-hags. The former 
are simply folded cloths or pledgets of absorbent cotton 
dipped in cool or iced water and squeezed just enough to 
prevent the water from flowing. They are laid upon the 
part — the eye, for instance — in which it is desired to dimin- 
ish the flow of blood, and hence to limit the inflammation of 
the part. For cooling a larger surface, the ordinary rubber 
water-bag may be partly filled with cold water and applied 
to the part. Ice-bags more suitable to special applications 
are made of thin rubber, which adjust themselves to the sur- 
face quite perfectly. The ice-cap is the commonest example 
of these. The opening is large enough to admit pieces of 
ice of considerable size, and is stopped with a cork. These 
ice-bags, however, are rather beyond simple domestic medi- 
cine, as without previous direction their use is not sure to 
be advisable. 

HOT APPLICATIONS 

Heat may be applied locally by means of the hot-water 
bag now in common use. If several sources of heat are 
needed they usually are to be had in bottles of hot water, in 
hot bricks or stones (all, of course, to be enveloped in wrap- 
pings, preferably of wool), in bags of sand, or of salt heated 
in the oven. 

A moist local application of heat constitutes a fomenta- 
tion. Usually cloths wrung out of hot water are used, 
applied over the part where pain is to be eased or to the sur- 
face of which it is desired to attract the blood. The stimu- 
lating effect may be increased by sprinkling the surface of 



156 THE CENTURY BOOK FOR MOTHERS 

the wrung-out cloth with tincture of camphor. Applica- 
tions of spirits of turpentine used in this way or simply 
sprinkled upon a dry cloth and applied are called stupes, 
but the word really means any fomentation. Turpentine 
stupes and stupes of hot mustard-water are very stimulat- 
ing to the skin, but should be used with the greatest care 
on children too young to quickly express their feelings, as 
an undesirable amount of irritation can be easily produced. 
Mustard should not be used upon an unconscious person. 
The chief use of stupes is in cases of abdominal troubles. 
Camphorated oil produces a gentle stimulation of the skin, 
and is a popular remedy in infantile chest disorders. It is 
however doubtful if it be of great value. 



POULTICES 

If it be desired to make a more prolonged local action of 
heat, poultices may be used. Their chief use is where heat 
and moisture are desired upon the skin; sometimes they are 
of a nature to be directly soothing to the parts beneath. 
They may be made from many substances, as, for instance, 
any kind of meal, of which flaxseed-meal has the best con- 
sistency for the purpose, or ground slippery-elm bark, which 
has no particular advantage over the flaxseed and is much 
dearer; bread and water, or bread and milk. Various vege- 
tables, such as onions and potatoes, have had popular repute 
for this purpose. 

The traditional uses of poultices are to quiet local inflam- 
mations and to hasten suppuration when it is inevitable, as in 
ordinary boils. Formerly they were used for many pur- 
poses to which a hot-water bag is now applied. The use 
of large poultices upon the chest in disorders of that region, 
especially in pneumonia, is common. They are probably use- 
ful if skilfully used, but otherwise they are not. To rouse 
the feeble respiration of a sick child the poultices must be 
applied hot, but not too hot; must be changed frequently, 
every half hour at the longest, and changed with speed, the 



DOMESTIC TREATMENT OF ILLNESS 157 

new one being ready before the old one is removed. All this 
requires dexterity, and usually two pairs of hands. 

Poultices should not be used carelessly. Never poultice 
an eye without specific order of the physician. 

Stimulant poultices are made by adding to the ordinary 
material some proportion of mustard. A mustard-plaster 
is a poultice entirely or largely of mustard. For young 
children the latter are usually to be avoided. Plasters made 
in a similar manner from the various ordinary spices are 
warm enough for young skins. 



HOW TO APPLY POULTICES 

The making and application of poultices require a little 
knack or knowledge. The materials used may be various, as 
just mentioned. Whatever is used, the mixture must be, 
when done, entirely smooth ; nothing hard or harsh is admis- 
sible. If bread and milk or bread and water be the materials, 
the boiling water should first be poured into a hot bowl, or 
the water may be heated in a saucepan. In either case the 
bread-crumb, no crust, should be broken into it and the 
whole beaten together with a fork, to keep the mass as light 
and soft as possible. Flaxseed-meal or ground elm-bark may 
be stirred into the hot water and heated till the mass boils 
or steams and becomes soft. A poultice should not be so 
stiff as to be harsh, nor so thin as to run. A beginner is 
likely to use too much water. 

Any soft, thin fabric of sufficient strength will do for 
a poultice cloth. Of late years the porous materials known 
as cheese-cloth and butter-cloth have in great degree dis- 
placed others. Thej^ are very suitable to the purpose, and 
so very cheap that they may be thrown away without thought. 
Bags of these materials of suitable size may be made, into 
which the poultice mass is filled when ready, and the open 
side stitched up, or a suitable piece of the stuff may be laid 
upon a hot plate and the mass spread half an inch thick or 
more, the edges turned over and stitched together if they 



158 THE CENTURY BOOK FOR MOTHERS 

do not remain in place without. The poultice should be 
always large enough to considerably more than cover the 
surface to be acted upon; a boil, for instance, having a red- 
dened surface two and one half inches across, will require 
a poultice four inches square at least. 

One of the inconveniences of poultices is their drying and 
sticking to sensitive surfaces or to parts upon which short 
hairs grow. This may to a great degree be obviated by first 
putting oil or vaseline upon the surface of the skin or of 
the poultice; and both the drying and cooling may be hin- 
dered by placing over the poultice a piece of oiled silk or 
gutta-percha tissue, and over it again some cotton batting, 
the whole to be kept in place by a bandage or the like. The 
older method of making poultices covered on one surface 
only with cloth favored this sticking, but the open-textured 
kinds of poultice cloth mentioned may cover both surfaces 
of "the poultice mass, one lying between the latter and the 
skin. 

In putting on a poultice let it approach the surface to 
w^hich it is to be applied gradually, and put it in place as 
soon as the heat can be borne. It usually needs renewal in 
a few hours— two to four, on an average. 

In the absence of any suitable poultice material, a tem- 
porary substitute may be found in a thick piece of cotton 
batting or, still better, absorbent cotton, dipped in hot water, 
pressed partly dry, and applied and treated, as to covers, 
as advised for a poultice. 

JACKETS FOR THE CHEST 

So, also, some of the advantages of a poultice may be ob- 
tained by the use of the cotton and oiled-silk jacket for 
the chest. Without the oiled silk, the cotton simply makes 
an additional protection against chilling. It has the ad- 
vantages and disadvantages of excessive clothing. When the 
oiled silk is used the perspiration converts the cotton into 
a permanent poultice. This was, not may years ago, a rou- 



DOMESTIC TREATMENT OF ILLNESS 159 

tine application in pneumonia. It is probably much less 
used at present. The jacket is made of muslin or similar ma- 
terial, made to go quite around the chest and hollowed out to 
admit the arms. To it the layer of cotton is basted thor- 
oughly to prevent its shifting. A soft inner lining in addi- 
tion is still better. It is tied around the chest and over the 
shoulders with tapes arranged for the purpose. If oiled 
silk is used, it is modeled to fit the shirt, and also tied in 
place. 

CATHARTICS 

In a great many of the disorders of infancy and child- 
hood evacuation of the bowels by remedies is necessary or 
advantageous. In fact, it is rarely out of place. In child- 
hood the intestinal canal very often contains improper food 
or an excessive amount of food otherwise proper. In in- 
fancy the intestinal contents are often the results of imper- 
fect digestion of food. In all these conditions the clearing 
out of the canal is essential to the prompt relief of the mal- 
ady, even if it be one not immediately caused by the diges- 
tive state. Hence the important part played by laxatives 
or cathartics in domestic medicine. The treatment of habit- 
ual constipation is not here considered. For clearing out the 
canal promptly two remedies may be mentioned. First, cas- 
tor-oil. On the whole, it is the surest and safest of cathartics 
for domestic use. It not only acts as such, but in many dis- 
turbances of the digestive tract is additionally beneficial. 
The dose for clearing out the intestinal canal should be a 
tablespoonful, say, at four years of age, half that— -i. e., a 
dessertspoonful— at one year, and a teaspoonful by a half 
year is usually well borne if needed. 

CALOMEL 

If there is vomiting or nausea, calomel is a better cathar- 
tic. It helps to quiet the stomach. There is no difficulty 
in giving it. The best method is to use the triturates so 



160 THE CENTURY BOOK FOR MOTHERS 

generally found in the pharmacies at the present time. Tri- 
turates of one tenth of a grain are very convenient for gen- 
eral use. One hourly may be given for several doses, ac- 
cording to the age of the child. A child of a year may take 
ten doses in this manner, but if the bowels move early, 
especially if the greenish color of the calomel stool is noticed, 
the doses should be stopped. Children bear calomel in pro- 
portionally larger doses than do adults, but this is not a 
reason for overdosing. 



THE GIVING OF AN ENEMA 

When the bowels are simply constipated, an enema may 
give all necessary relief, or a suppository may serve. Vari- 
ous syringes are recommended for enemas of children, but 
it is not usually worth while to multiply apparatus, espe- 
cially if of rubber, which deteriorates very rapidly if not 
in frequent use. It is better to become expert in the use 
of some one kind. Hence the bulb or bag syringe j which can 
be used for many things, is generally used. It is true that if 
the enema is needed for a very young infant, the syringe 
which consists of a bulb with a soft-rubber nozzle, without 
an intervening tube, is convenient, because it can be used with 
one hand. The hard-rubber syringe, wdth a plunger or pis- 
ton, is convenient for giving definite amounts of medicated 
liquids. On the whole, the bag syringe is the most conve- 
nient. The enema, say of soap-suds, is prepared preferably 
in a pitcher. For a very young baby a half pint should be 
prepared, as some will be wasted in the syringe. For an older 
child at least a pint will be needed. Hang the bag at a 
small elevation, not over two feet above the infant, as the 
object is to inject the liquid gently, as it is thus less likely 
to be prematurely expelled. Attach a small nozzle to the 
tube, and lubricate it with oil or vaseline. Fold a thick 
towel beneath the child's hips. When this is ready pour 
the enema into the bag. The bag will slightly cool the liquid, 
so it should be mixed more than blood-warm. Introduce 



d 



DOMESTIC TREATMENT OF ILLNESS 161 

the nozzle, the child being on its back or left side. Gather 
up some folds of the towel about the nozzle, to make pres- 
sure against the bowel so as to help the retention of the liquid 
and open the pinch-cock of the tube attached to the bag. If 
the child after a while endeavors to get rid of the liquid, close 
the pinch-cock, as the feeling may subside and more be given. 
If it does not subside, the vessel, w^hich was placed at hand 
before beginning, is placed to the child or the child upon it. 
One Avho has learned to give an enema well can easily 
learn to irrigate the bowel, as may be necessary in diarrhoeal 
diseases. But as it will be ordered and demonstrated by the 
physician it will not be here described. 



11 



XII 



HINTS REGARDING THE ADMINISTRATION 
OF MEDICINES 

THE giving of medicines often requires a little tact, and a 
knowledge of details helps exceedingly to their success- 
ful administration. Before entering upon these details, a 
few general remarks may be made. 

First of all, we would deprecate the practice often in- 
dulged in by the ignorant, and sometimes by those who 
should know better, of holding up the physician as a buga- 
boo and the administration of medicine as punishment, or, 
at the least, a thing to be dreaded. Medicines sometimes 
are unpleasant, more commonly they need not be, and in any 
case it is the part of wisdom to prepare the way for a possible 
need by speaking of remedies as helpful rather than as 
objectionable, and of the physician as a family friend in 
time of need rather than as a beadle or nursery executioner. 
This advice is fortunately now less necessary than formerly, 
and the "Doctor" is in many houses quite as popular in 
the nursery as he is anywhere. And we have known certain 
pious frauds to work to advantage, such as in families 
where candies are rarely admitted, to call them always ' ' med- 
icine, ' ' which name therefore became associated with a pleas- 
ant rather than an unpleasant thought. 

Another general suggestion is this : Do not make a parade 
or fuss in getting your remedy ready. If anything of the 
sort be necessary, let it be done out of the child 's sight, and 
the remedy be brought when ready for administration; it 
may then be swallowed without objection, while, if time had 

162 



ADMINISTRATION OF MEDICINES 163 

been allowed, antagonism would have been excited. Make 
the giving of each dose as tidy as possible. 

If doses are to be given frequently, or for some time, it 
is of help to make out on a slip of paper a schedule of hours 
for them, and as each dose is given draw a line through that 
hour. This shows, afterward, not only when the dose should 
have been giv^en, but that it was given. The plan is espe- 
cially useful to avoid confusion when more than one remedy 
is required. The tumbler covers Avith dials are handy, but 
only when the medicine is in liquid. form. 

LIQUID MEDICINES 

Liquids constitute the chief form of medicine given to chil- 
dren, owing to their inability, as a rule, to take other forms. 
If a medicine has little taste, or at least little disagreeable 
taste, this form is unobjectionable; but otherwise the other 
forms are preferable as soon as the child is old enough to 
take them, as in them taste can m one way or another be 
hidden. Medicines are sometimes insoluble, and must then be 
given in some more solid form. It should be remembered 
that some infants dislike to take anything into the mouth 
except by sucking. It is rather hard to teach such chil- 
dren to take even a drink of water from a cup or from a 
spoon. 

WAYS OF GIVING MEDICINES 

It is of advantage to give water even to the youngest suck- 
ling, and it is an additional reason for so doing that by 
this means the child learns to take liquids from a spoon or 
cup, and has less difficulty in taking medicine in case an 
emergency arises. If a medicine is prescribed by a physi- 
cian, learn from him just how it is to be given, even as to 
the amount of water in which each dose is to be adminis- 
tered. This latter point may not be important in many 
cases, but in some it may. For instance, saline medicines 



;i 



164 THE CENTURY BOOK FOR MOTHERS 

largely diluted may act upon the kidneys, while if less di- 
luted they would more probably act upon the bowels. 

As a rule, medicines w^hich are in any degree pungent or 
which might be irritating, should be largely diluted, or water 
be given directly afterward. On the other hand, medicines 
which have a decided taste should be diluted as little as is 
consistent with the foregoing rule, in order that the disagree- 
able taste may not be unduly prolonged. It is not good 
policy to sweeten such medicines, but rather to give the 
douceur, whether a sweet or a tasty fruit, immediately after- 
ward. Sometimes a decided taste, as of orange juice, in the 
mouth just before the medicine, is an excellent disguise, 
especially if it be repeated just afterward. We will speak 
of this more fully presently. 

HOW TO PREPARE A DOSE 

If a liquid is to be given in doses of a certain number of 
drops, especially if given frequently, much time and annoy- 
ance may be saved by mixing a number of doses at once. For 
instance, suppose the physician has ordered that a drop of 
tincture of aconite be given every hour or half hour until 
certain effects are produced. The giving of a single drop 
thus often is sometimes difficult, especially with the agi- 
tating circumstances which attend a baby's illness. It is 
then better to put into a tumbler or some other convenient 
vessel a certain number of drops of the medicine, it does 
not much matter just how many, if they be counted. Then 
add the same number of teaspoonfuls of water, and mix thor- 
oughly by stirring. Evidently each teaspoonful will contain 
one drop of the aconite, and it is only necessary to stir the 
mixture well before each dose and to take up the teaspoonful 
to insure the proper quantity. If the dose is to be larger, 
it is easily obtained by giving the requisite number of tea- 
spoonfuls, or, if smaller, by adding a proportionately larger 
number of spoonfuls of water at the start. In any case drop 
out the medicine before adding the water. 



ADMINISTRATION OF MEDICINES 165 

IRON PREPARATIONS 

In spite of the advances of pharmaceutical chemistry, it 
is sometimes necessary to give solutions containing acids 
either as such, or as helping the solution, like some prepara- 
tions of iron. These solutions "set the teeth on edge," and 
fears are naturally entertained, and sometimes with reason, 
lest the teeth be injured. In such cases it is well, unless 
the physician has a reason to the contrary, to resort to the 
following device to prevent harm. Before giving the dose, 
dissolve a little baking-soda, say a good pinch, in a third of 
a tumbler of water ; w^arm water we prefer. As soon as the 
acid dose is taken, let the patient rinse the mouth mth the 
soda, which neutralizes the acid and removes the "on-edge" 
feeling. If the child is too young to do this, wash the mouth 
with a rag dipped in the soda. Older children can also pre- 
vent harm to the teeth by the use of a tube or straw in tak- 
ing the acid. 

CASTOR-OIL 

Oily liquids require some special attention. As has been al- 
ready said, in domestic practice, and on the whole wisely, cas- 
tor-oil plays an important role. But its giving need not be 
made so difficult as it often is. If the oil is fresh and of good 
quality, its taste is not nearly so bad as that of many things 
more readily taken. If through carelessness the oil becomes 
rancid, it is a nauseous dose. Oils exposed to the air, espe- 
cially in warm places, easily undergo changes, and the follow- 
ing precautions should be observed as regards castor-oil, cod- 
liver oil, emulsions of either, or of almond oil, often used in 
cough mixtures. Keep them always in as cool a place as prac- 
ticable. Before giving a dose, see that the neck of the bottle 
is clean on the outside. Pour out the dose carefully, and 
clean the stopper and neck inside and out before the former 
is replaced ; then cork tightly. The reason of this is that if a 
film of oil is left exposed to the air it soon becomes rancid, 
and in pouring the next dose some of the rancid oil goes 



166 THE CENTURY BOOK FOR MOTHERS 

with it— enough to give a taste ; and when the pouring ceases, 
the oil that returns to the bottle carries with it some of the 
rancid oil, enough often to set up a similar process in the 
bottle. Similar precautions are useful, but not so neces- 
sary, for syrups or thick solutions containing gum or sugar. 

In administering oils (and we may take the castor-oil as 
a type) it should be remembered that a good deal of the ob- 
jectionableness is due to the viscidity. Therefore, first heat 
the spoon by immersion in hot water, or in any other way. 
If the child is old enough to be allowed, or to have acquired 
a liking for, sapid things, it is well to squeeze a little orange 
juice into the hot spoon, then pour in the oil and squeeze a 
little more juice over it. The heat of the spoon makes 
the oil flow more readily, and the juice above and below 
renders it hardly recognizable. If the baby is so young as 
to object to the spoon per se, there is no use in trying to dis- 
guise the oil, but this heating of it or of the spoon is always 
helpful. 

This is a proper place to say that we believe that much 
of the disgust manifested by children for medicines is sim- 
ply imitation of their attendants. When, many years ago, 
we were told by an old physician that children rarely ob- 
jected to cod-liver oil unless they had seen their elders make 
a face at it, we were surprised ; but experience has convinced 
us of the correctness of the statement. So far as we have 
observed, more children actually like cod-liver oil emulsions, 
for instance, than object to them. 

MEDICINES IN SOLID FORM 

To little children, powders, pills, capsules, and tablets are 
often more difficult to administer than any liquid. This is 
frequently so because to them swallowing has been an auto- 
matic act, and when they endeavor to swallow, even with 
the best intent, a small object, it is likely to lodge in some 
part of the mouth over which the child has little control. 
This, and not the covering of the taste, is the secret of the 



ADMINISTRATION OF MEDICINES 167 

success of the old-fashioned device of hiding the pill or 
powder in a good-sized crumb of bread. A large and suffi- 
ciently soft bolus is thus formed Avhich the tongue can readily 
manage. The draught of water acts in the same way. It 
can be swalloAved, and with it goes the dose. This also is 
one of the advantages of the wafer-paper used in adminis- 
tering medicines. Common thin white tissue-paper will 
serve to hide a bitter powder if no better cover is at hand. 
It may then be taken as a pill, placed well back on the tongue 
and swallowed immediately with a full draught of water. 
The paper is harmless. 



SWALLOWING MADE EASY 

There are one or two points about the physiology of swal- 
lowing which, if understood, are helpful— namely, first, that 
swallowing is made easy by the action of the saliva moist- 
ening the mass to be swallowed ; but if, to avoid taste, speedy 
swallowing without time being allowed for insalivation be 
required, or if by reason of fever the mouth be dry, swal- 
lowing will be more than usually difficult. Hence another 
reason for the drink of water. Secondly, that, while the 
passing of the bolus to be swallowed through the mouth 
proper is done by the muscles of the tongue, which are vol- 
untary muscles even if they act unconsciously, when the 
bolus reaches as far back as the uvula it comes within the 
domain of muscles which act spasmodically and force it down 
the throat. Every child knows that if it allows a candy to 
get too far back on the tongue, it "slips down the throat." 
Hence, if by reason of nervousness or of anything else a pill 
cannot be swallowed, it is only necessary to. place it upon 
the back of the tongue, and it must go. If there is left a 
sensation that it has ''stuck" anywhere, a draught of water 
will remove it. 

Generally speaking, a little tact in the management of chil- 
dren will avoid the unpleasant scenes so often associated 
with the giving of medicines, 



168 THE CENTURY BOOK FOR MOTHERS 

RULES FOR THE SICK-ROOM 

In taking care of a sick child, the same sort of common 
sense is called for as in any other nursing. The cardinal 
rules are watchfulness, quiet, calm demeanor, and cheerful- 
ness. Fussiness and agitation are very communicable. En- 
gage the child's confidence by strict truthfulness in what- 
ever you say, and by gentleness in whatever you do. But 
gentleness is not to be understood as meaning weakness or 
lack of discipline. If a medicine or any remedy is ordered 
it is to be given, and a gentle compulsion is less exhausting 
than weak controversy. If there is any genuine obstacle to 
the execution of the physician's orders, if it be explained to 
him he can doubtless manage in some other way. 

In any case in Avhich a physician is called, write down 
his orders, unless he does so himself before he leaves, so that 
there shall be no misunderstanding. If several things are to 
be done, make a little schedule of the hours at which they are 
due. It is quite convenient to have a manuscript book, such, 
for instance, as school exercises are written in, in which to 
write the physician's orders. If on the opposite page a 
memorandum is made of the nature of the illness or of its 
symptoms and of the remedies, quite a useful guide is made 
up, which is especially applicable to the child concerned, 
perhaps to the entire family of children. 



XIII 
NURSERY EMERGENCIES 

THE management of emergencies, due in most part to 
accidents, may be considered under the head of Domes- 
tic Surgery. In addition, there will be mentioned in this 
connection a fcAV emergencies which are not strictly surgical, 
but must be met with surgical promptness. A large num- 
ber of medical situations, more or less emergent, are con- 
sidered in the second part of this book. 

DOMESTIC SURGERY 

This covers the care of some minor injuries, as well as the 
temporary care of more serious ones. Among the various 
wounds to which children are liable are incised wounds, or 
clean cuts; lacerated wounds, or tears and scratches; punc- 
tured wounds, such as are made by sharp, slender stabbing 
things — in the nursery, needles and splinters are commonest, 
and later fish-hooks and pointed tools are added. To these 
may be added punctured poisoned wounds, commonly the 
bites of insects, and, very rarely, the bites of animals which 
may be poisonous. In dealing with any wound, the first 
duty is to make sure that it is clean. If the wound be 
simply incised and made with a clean blade it will prob- 
ably be clean enough if washed with simple boiled water, 
into which salt— a teaspoonful to the pint— is dissolved. If 
the water be as hot as can be borne, it will considerably aid 
in stopping the flow of blood. If the latter be not rapid, 
it may alone suffice. If blood spurts, an artery has been 

169 



170 THE CENTURY BOOK FOR MOTHERS 

cut, and the jet is best stopped by pressure either upon the 
spurting-point or by pressing together the lips of the wound. 
Pressure may be made directly with the fingers or with a 
bit of absorbent cotton, gauze, or linen. When all is clean 
and dry, the lips may be brought together neatly and so held 
by strips of adhesive plaster and covered with a pad of gauze 
and a bandage. All wounds upon the face require especially 
careful adjustment, on account of future appearances. 



RAGGED WOUNDS 

If the wound be ragged, such as is made by a scratching 
or tearing implement — nails, tacks, and many similar ones — 
more care will be required in cleansing the wound and in 
adjusting its edges, while the bleeding is usually more read- 
ily stopped. For this cleansing, an antiseptic solution will 
be needed. If no other is at hand, the salt solution before 
alluded to will do, but it is better to have a saturated solu- 
tion of boric acid or a bichlorid-of-mercury solution. Tab- 
lets of this latter salt are sold, one of Avhich, dissolved in a 
pint of water, makes a solution of one part in one thousand, 
the usual strength for use. Cleanse the wound carefully and 
thoroughly with a wad of absorbent cotton dipped in the 
solution used. When it is entirely clean, dry and close it 
as before. Remember that the solution is very poisonous if 
swallowed. 



THE CLEANSING OF PUNCTURED WOUNDS 

Punctured wounds require even more care in the cleansing, 
as it is not easy to be sure that nothing remains within. 
When everything has apparently been cleaned out let the 
part be soaked in the antiseptic solution before wrapping it 
up. A little different procedure is required according to 
the nature of the puncturing substance. A needle is usu- 
ally not dirt}", but is likely to break in the flesh. If any 
part projects, extract it with great care, pulling in the line 



NURSERY EMERGENCIES 171 

of the projecting part. If the needle be broken and the 
remainder imbedded, do not throw away the part which is 
found until the physician has seen it. It may aid him in 
finding the other part. Pins are often not clean, but do not 
break; their wounds need cleansing especially. Still more 
is cleanliness necessary after the extraction of a splinter, 
as the latter is quite likely to be foul. The splinter, if large, 
can be withdrawn with the fingers, but if small some sort 
of forceps or tweezers is necessary. Splinters under the 
nails are particularly troublesome, as they often break off 
close to the nail margin and cannot be grasped. In the 
absence of a physician or any proper instrument, a penknife 
blade may be used. It should be first washed and then made 
clean by holding it in the steam of a tea-kettle or in boiling 
water. The nail can then be scraped thin and notched with 
the knife, and the end of the splinter may then be reached. 
In case of failure, the splinter is loosened by the suppuration, 
and usually is thus easily dislodged. But this last process is 
painful, and may involve risks. 

The difficulty in removing fish-hooks comes from the barb. 
They are best removed by pushing the point through the 
flesh if practicable, when the whole hook is drawn through, 
or the barb broken off and the hook withdrawn, as may 
seem easier. Occasionally they are so imbedded as to re- 
quire a knife for their removal. Fish-hook wounds need 
the antiseptic application to be pretty thoroughly made. 

The poison of insect punctures rarely causes more than 
local irritation. This is usually relieved by alkaline appli- 
cations, such as ammonia or soda in water, by a solution of 
borax, one or two teaspoonfuls to a pint of water. Camphor 
tincture and alcohol are also much used. 

The wound of dog-bite, while usually only a punctured 
wound, may be a poisoned one. The uncertainty in this re- 
gard is only indefinitely prolonged by killing the dog. If 
he be kept, and is rabid at the time of the biting, he will 
not long survive, and the necessary treatment of the wound 
may be instituted. In all cases of doubt, and especially if 



172 THE CENTURY BOOK FOR MOTHERS 

the dog has been killed or, as in the case of a vagrant dog, 
has escaped, the wound should be cauterized with a hot iron, 
in addition to the cleansing with the antiseptic solution which 
is applied to every punctured wound. 

In those regions where poisonous snakes exist, bites from 
them may occur. Until the physician arrives, girdle tightly 
the bitten limb above the wound, squeeze out all the blood 
possible from the latter, and lay on an antiseptic dressing. 

BRUISES AND BUMPS 

Bruises and bumps are among the commonest injuries of 
childhood. If the skin upon the bruised place is broken, the 
injury is converted into a lacerated wound, and is to be 
treated according to the general rules already given. If the 
skin is not broken, the treatment is directed to the diminution 
or prevention of the pain and swelling, as well as the subse- 
quent discoloration due to the effusion of blood beneath the 
skin. The applications may be hot or cold, but they should 
not be alternately both nor half-way. If hot water, which is 
preferable, is used, persist with it. If hot water is not at 
hand or easily had, stick to cold water. The effect of either is 
increased by making some pressure with the cloth by which 
the hot or cold water is applied. A bump on the head may 
be attended with concussion of the brain, or stunning, which 
for the moment takes precedence of the bump itself in atten- 
tion. The child in this case should be allowed to lie quiet. 
If the surface is cold, hot bottles or other sources of heat 
should be put about him. It is unwise to give alcoholic stim- 
ulants in any amount, as they increase the subsequent head- 
ache. Ammonia is better. Vomiting generally announces 
the commencement of the rallying. 

Besides the water applications spoken of, alcohol and water, 
witch-hazel extract, and a variety of well-known things are 
in common use. It is, however, doubtful whether they 
have any advantage whatever over the simple water com- 
presses. 



NURSERY EMERGENCIES 173 



SPRAINS 



Sprains are wrenchings of the soft parts about a joint 
\\dthout injury to the bony parts. They vary greatly in 
degree. It is very important to be sure that the bones have 
escaped injury. Therefore a sprain of any considerable se- 
verity needs an examination, at least, by a physician. For 
milder sprains, in which there is no question of a break, the 
most successful treatment consists in putting the injured 
joint, if practicable, into water as hot as can be borne, the 
heat being kept up by additions of hot Avater. If this can- 
not be done, an ice-bag may be applied. After the joint is 
thus made comfortable, it may be made firm by the appli- 
cation of strips of adhesive plaster, when the use of the limb 
may be resumed. This plan of treatment is most applic- 
able to sprains of the ankle. If there is reason to suspect a 
fracture, the injured part is to be put into as comfortable 
a position as possible and supported there until the physician 
can see it. 

BURNS AND SCALDS 

Burns and scalds differ only in their causation, the one 
being caused by dry heat, the other by hot liquids. Severe 
and extensive burns are among the gravest of injuries. 
Slight ones can be treated by putting upon the surface bi- 
carbonate of soda either dry or in solution, or a solution of 
carbolic acid in water, a teaspoonful of the former to a pint 
of the latter. As the carbolic acid does not always dissolve 
perfectly without waiting, it is well to have the solution 
on hand, as it is useful for almost all antiseptic washes, as 
well as for burns. Oils are also useful to cover the sur- 
face, and the mixture of linseed-oil and lime-water, known 
as carron oil, while not very elegant, is very useful. AVhat- 
ever is used for the application, the surface is to be pro- 
tected from the air by a covering of cotton, gauze, or 
linen. 



174 THE CENTURY BOOK FOR MOTHERS 

CAUTIONS AS TO FIRE 

It is well to know and to teach servants and older children 
how to manage a child whose clothing has caught fire. It 
must not be allowed to run about. It should be thrown 
down, or throw itself down, to keep the flames from the face, 
and be Avrapped in any heavy woolen thing at hand— rug, 
blanket, heavy woolen garment, or what not. When the fire 
is extinguished, the clothing should be taken off carefully, 
cutting it away from the burned parts to avoid additional 
injuries to these last. Stimulants, such as wine, spirits, 
coffee, or tea, may be called for if there is great shock. 

FROST-BITE AND CHILBLAINS 

Quite the opposite as to cause are frost-bite and chilblains. 
The frost-bites in children are usually of especially exposed 
parts, such as the ears, tip of the nose, and sometimes of fin- 
gers and toes. If after or during exposure to great cold any 
of these parts be noticed to be abnormally white, freezing 
may be suspected. The circulation should be stimulated by 
friction, Avhile a sudden change of temperature is avoided. 
A favorite method of stimulation is to rub the affected parts 
with snow. Indoors, applications of ice-cold water may be 
made before the sufferer enters a warm room. The chilblain is 
an incomplete frost-bite of a part which has not been guarded 
against a sudden change of temperature, the minute blood- 
vessels having lost their tone from violent change. Chilblains 
may sometimes be prevented or mitigated by the same ap- 
plications as are recommended for frost-bite. In strong, 
healthy children chilblains are distressing from their burn- 
ing and itching; in feeble children they may even be a 
serious malady. The care of them, if they have been estab- 
lished, consists in keeping the feet dry, in wearing spacious 
shoes, besides sometimes making soothing applications. The 
itching sometimes yields to alkaline baths, sometimes to sim- 
ple cold foot-baths. For the feeble, tonics are necessary. 



NURSERY EMERGENCIES 175 

REMOVAL OF FOREIGN BODIES 

A COMMON mischance of the nursery is a foreign body in 
the eye, in the ear, nose, or somewhere in the alimentary 
canal. Only rarely does one get into the air-passage. With 
the exception of things in the eye, all these accidents are the 
result of the child's own meddlesome habit of tucking away 
things. In the eye may be lodged cinders, dust, small par- 
ticles of any kind, as well as loosened eyelashes. Any of 
them may give a good deal of discomfort, or even suffering, 
if allowed to remain. A convenient instrument for the re- 
moval of such a body can be made by winding a bit of ab- 
sorbent cotton about the end of a wooden toothpick or a 
similar bit of wood or a tape-needle. When it is ready, look 
at the eye to see if the object to be recovered is in sight. 
If so, it can be quickly wiped away with the swab just 
made with a sidewise motion, the child's head being firmly 
held meantime. If it is not in sight, depress the lower lid 
and search. If this fails, the upper lid must be searched, 
and perhaps turned over. This is done thus: First, the 
upper lid is seized by its margin and the lashes and drawn 
down over the lower lid. The motions of the eye, involun- 
tary or, in the case of an older child, voluntary, may dislodge 
the object, so that it will be found on the outside of the lower 
lid when the upper one is released. If this fails, seize the 
upper lid as before, lay upon its outer surface some small 
cylindrical thing, such as the small end of a penholder, hold 
it firmly, and turn the lid up over it. Examine the exposed 
inner surface, and if the object is found, wipe it off as before 
described. Small fragments of steel often lodge themselves 
too firmly for removal by these gentle measures, and a physi- 
cian 's skill and appliances are needed. If an eye is wounded, 
only cold applications are permissible until the physician 
comes. 

Substances in the nose may be expelled by nose-blowing 
or by sneezing if excited by tickling or otherwise. Clumsy 
manipulation sometimes wedges them in more firmly than 



176 THE CENTURY BOOK FOR MOTHERS 

before. Therefore, before endeavoring to remove a foreign 
body examine to see if it can be easily gotten at, and, if so, 
whether you have a suitable extractor. The bent, round end 
of a hairpin can often be made into a successful implement. 
In the majority of cases it is safer to leave the case to the 
physician. 

The same caution applies to things introduced into the 
ear. Often the difficulty which the physician experiences in 
removing a foreign body is largely due to previous unskilful 
attempts. If the body does not fall out when the child is 
laid with that ear down, or if it does not come out with 
gentle syringing, domestic attempts would better stop. Lit- 
tle harm can arise from its temporary stay in the ear- 
passage. 

Foreign bodies in the throat— that is to say, in the pharynx 
—may sometimes be dislodged by inverting the child and 
giving it a smart blow on the shoulders. Sometimes the 
bodies are sufficiently visible to be extracted by the finger 
while the child is inverted. If the body has been swallowed, 
—i.e., has gone into the stomach— the most advisable plan, 
if the child be old enough to take such articles with safety, 
is to give it bulky food, such as potato or bread, the body 
being usually carried through the alimentary canal with 
them and being found in the faeces. 



NOSEBLEED 

Various causes combine to make nosebleed a common oc- 
currence. It is in later childhood that it occurs, rather than 
in infancy, and in childhood it is rarely alarming in extent. 
Among the common, as well as the most useful, domestic reme- 
dies are quiet, recumbency with head raised, cold to the 
back of the neck or to the root of the nose between the eyes, 
pressure on the nose at that point, pressure upon the upper 
lip, and the raising of the arms high above the head. If the 
bleeding be from a blow upon the nose, pains should be 
taken to make sure that this organ is not broken. It is sur- 



NIJRSERY EMERGENCIES 177 

prising how frequently such injuries are not recognized until 
deformity has occurred. 



RESUSCITATION IN DROWNING ACCIDENTS 

Drowning is fortunately a rare accident, but when it does 
occur the efforts at resuscitation must be immediate. The 
efforts of a bystander applied at once may succeed. No 
effort, even the most skilful, can avail after much delay. 
Therefore, as soon as the body is taken from the water to a 
place of safety, work should be begun. For popular use, 
a method of resuscitation needs to be not only efficient but 
simple. To the writer, the method of Dr. Satterthwaite 
seems, on the whole, to unite these qualities. It is briefly 
described below. 

1. While one is at work upon the drowned person, others, 
if present, should endeavor to get dry covers and clothing— 
their own will do— and hot water, or make a fire by the 
water-side to heat articles. If nothing else can be had, the 
stones upon the beach can be heated. 

2. The operator first endeavors to empty the water from 
the patient. ''To do this effectively, roll the person over 
on the face, which should be a little lower than the body; 
if the bank be shelving, let the heels be higher than the 
head ; then wedge open the mouth and keep it open by a bit 
of wood or by a knot in a handkerchief. The tongue should 
also be depressed. Then, getting astride of the person, press 
with the flat of the hand upon the abdomen, so as to push 
up the diaphragm. In half a minute, or probably less, the 
water will be driven out sufficiently to allow efforts at arti- 
ficial respiration to be made. 

3. "Then turn the person on to the back, place him in a 
horizontal position, keeping the mouth wedged open as be- 
fore and the finger on the back of the tongue, and make pres- 
sure again with the hand upon the abdomen, so as to press 
the diaphragm upward. Make pressure slowly at first, and 
then force the air out. Then withdraw the hand, that the 

12 



178 THE CENTURY BOOK FOR MOTHERS 

diaphragm may fall and the lungs inflate with air. . . . 
At first make three or four movements in a minute, then in- 
crease to ten or fifteen, and persevere at that rate until there 
are evidences of returning respiration or it is plain that life 
is extinct." 

This plan permits the simultaneous use of the Sylvester 
method, if one familiar with it be present, but for those un- 
used to such emergencies complicated methods are apt to 
defeat themselves. Rubbing the person, giving ammonia to 
smell, and, above all, the use of hot applications— hot water 
if it can be had— at as great a heat as the hand will bear, are 
valuable. If the patient revives, he is to be taken to a quiet 
place, where hot broths, beef-tea, hot tea or coffee, or alco- 
holic drinks in moderation may be given. 

CONVULSIONS 

Probably the most alarming emergency in the nursery not 
due to an accident is the occurrence of convulsions. The 
causes of these are manifold, and the management of them 
beyond the range of domestic medicine. The drugs most 
relied upon by physicians, such as chloroform, its relative, 
chloral, and morphia, are not to be used Avithout knowledge. 
If a physician can possibly be had, he should, of course, at 
once be sent for. While he is coming, the parent should 
endeavor not to do harm. The child should be kept as quiet 
as possible. The bed should be covered with a layer or two 
of blanket, and the child, undressed with the least possible 
disturbance, be laid upon it. Then he should be enveloped 
in a mustard pack, or, if the mustard be not at hand, in a 
simple hot pack. This is given by wringing out a sheet in 
hot water and applying it quickly all over the child. For the 
mustard pack, the mustard is added to the hot water before 
the sheet is dipped. The usual strength is a tablespoonful 
of mustard to a quart of hot water. A smaller amount of 
mustard will often suffice. When the skin is decidedly red, 
the pack may be removed. This will usually occur in ten 



NURSERY EMERGENCIES 179 

minutes. It must be watched, as the child can give no warn- 
ing, and the sensibility of the skin varies; a mustard burn 
is an ugly thing to heal. 

In the rare instances where no physician can be reached, 
in the absence of definite knowledge of the cause of the con- 
vulsion, it is fairly safe to assume that some digestive de- 
rangement is at fault. The bowels may be cleared out by 
a full enema or by irrigation, and if there is reason to sup- 
pose that food is still in the stomach itself, an emetic of the 
syrup or the wine of ipecac may be given. After the sub- 
sidence of the convulsions the child is to be kept quiet, and 
its nervous system still further soothed by the use of bro- 
mides for a few days. But it is to be always remembered 
that next to the quieting of the attack of convulsion, the 
recognition of the cause of it and the prevention of repeti- 
tions is the important matter. 

ACCIDENTS DUE TO POISON 

Accidental poisoning in the nursery is rare. If poisons 
are properly kept, or still more properly excluded, there is 
very little possibility of accident. Whenever it is thought 
necessary to have in the house a poisonous remedy, it should 
be kept safely out of reach of children, and if it be, as is 
the pharmaceutical rule, put in a colored or marked bottle 
and a memorandum of the antidote gummed to it, there is 
little chance of a mishap. Most such accidents as do occur 
are due to articles not medicinal, which are left about or 
allowed to fall where a child may get them; such, for in- 
stance, are match-heads, causing phosphorus poisoning; ox- 
alic acid, used to clean boilers and copper work ; in the coun- 
try, Paris green (aceto-arsenite of copper), used to kill 
insects. 

In the first place, it should be said that for every poison 
which has been swallowed an emetic is proper, although for 
the removal of some of them it may not be very efficient, 
owing to the blunting of the sensibility of the stomach. In 



180 THE CENTURY BOOK FOR MOTHERS 

any case, therefore, it should be tried. The emetic should 
be one of prompt action. Therefore, mustard and water, 
and strong soap-suds (laundry soap preferred) are among 
the best emetics. 

If the substance swallowed be an acid, it should be neu- 
tralized by an alkali. Here, again, suds from coarse soap 
is available and efficient as an alkali, as well as an emetic. 
Lime-water may be in the house, and can be used. So may 
chalk, the refined chalk known as Avhiting used for polish- 
ing silver, or magnesia. For oxalic acid, lime-water or chalk 
is best. 

If an alkali (potash, soda, lime, or ammonia in some irri- 
tating form) be swallowed, an acid is called for. Vinegar 
and lemon- juice are those most likely to be at hand. 

Carbolic acid deserves especial mention, as it is an acid 
only in name. The best antidote is thought to be one of 
the alkaline sulphates, such as Epsom salts or Glauber 's salts, 
both in use as cathartics. The Epsom salt is the more likely 
to be in the house. Give it freely and promptly. Creosote 
is comparatively little used nowadays, but poisoning from it 
is to be treated as if from carbolic acid. 

After the emetic and the antidote have been given, it is 
proper, if the poison is of an irritant nature, to give milk 
or white of an egg, oil, and soothing drinks. This is espe- 
cially true of irritating metallic salts, such as antimony (tar- 
tar emetic), arsenic (Paris green), verdigris or blue vitriol 
(both copper salts), corrosive sublimate (mercuric bichlorid), 
sugar of lead. But the exception of phosphorus must be 
borne in mind, because any oil renders phosphorus more 
soluble and more poisonous. 

Phosphorus poisoning is most likely to come from matches. 
A child may get a package and suck off the highly colored 
heads. The desirable emetic in this case is the sulphate of cop- 
per (blue vitriol), since it is not only an emetic, but the anti- 
dote as well. It may be repeated after vomiting has occurred. 
If time has elapsed for some of the poison to have passed into 
the bowels, they should be cleared with Epsom salts. 



NURSERY EMERGENCIES 181 

For any poison causing great depression, such as aconite, 
chloral, antipyrine, or phenacetin, stimulants, like alcoholic 
liquors, coffee or tea, and heat, are proper. 

For poisoning from any preparation of opium (morphine, 
laudanum, paregoric, etc.), the prime things after the emetic 
are to give coffee and to keep the patient awake by motion 
or in any other way. The physician will have additional 
resources. 

Occasionally a case of poisoning occurs in the country 
from the eating of some part of one of the plants of the 
solanaceae, the stramonium or jimson weed, the tobacco plant, 
the belladonna, or deadly nightshade, the last found in gar- 
dens but not a native plant. To these may be added some poi- 
sonous mushrooms, especially the poisonous species of amanita. 
The stomach must be emptied at once, and the bowels soon 
after. In the case of all these plants the poison is rendered 
insoluble, and therefore less active, by tannic acid or tannin, 
which is sometimes in the house. If in no better form, it can 
be found in a strong decoction of tea. The agreeable infusion 
made by skilful tea-makers is not so useful for this purpose 
as the decoction which the cook keeps stewing all day on the 
corner of the stove, since the latter contains all the tannic 
acid which can be extracted from the leaves. 

Of course, whatever the poison, medical aid should be sum- 
moned if possible. 



XIV 
THE HOUSEHOLD PHARMACY 

IN the previous chapters various medicines or remedies 
have been mentioned. It may be helpful to enumerate 
them again and to make a few suggestions as to their uses. 
It should first be said that if medicines are to be kept at all in 
the house, they should be together in a place provided for 
them and be always in order. For the purpose, a little cup- 
board is convenient, such as sold in furniture shops for 
the purpose. But a costly one is by no means necessary, 
and a little ingenuity will make a very convenient one from 
an ordinary box if nothing better is at hand. In the writ- 
er's opinion, it is far better to have a cupboard of this 
rude sort than to allow medicines to stand about on mantels, 
bureaus, on closet shelves, or in drawers mixed up with other 
things. Such Avant of system invites accident, and in emer- 
gencies often defeats the best intentions. The medicine cup- 
board should be in as cool a place as possible, and it should 
have a door or curtain, as many remedies keep better away 
from the light. 

CONVENIENCES ' 

Among the conveniences of this cupboard are measuring- 
glasses. Spoons have been used for generations as measures, 
and they do very well, but they vary somewhat in size, and 
different persons fill them more differently. Glasses marked 
by teaspoonfuls and tablespoonfuls are for sale, and the 
druggist's graduate glass is still more accurate. The latter 
is now sold not only by druggists, but by dealers in photo- 

182 



THE HOUSEHOLD PHARMACY 183 

graphic goods at very moderate prices. Still more useful is 
a little graduated glass to measure minims. These save the 
trouble of counting and are more accurate, since the minim 
is a fixed measure and is usually meant when a dose is 
stated in "drops," while the actual drop varies in size with 
the liquid and the orifice from which it is dropped. If such 
a measuring-glass cannot be obtained it is well to obtain 
from the pharmacist a medicine-dropper, which he finds 
delivers minims pretty accurately. In using it, the point 
is immersed in the liquid, the bulb compressed to expel the 
air, and when the pressure is released some of the liquid 
rises into the tube, whence it can be slowly pressed out, drop 
by drop. For putting liquids into the eye the droppers hav- 
ing a much finer outlet and giving small drops are com- 
monly preferred. AVhatever measure is used, always cleanse 
it thoroughly before it is put away. 

The fever thermometer, if one is owned, should be kept 
with remedies. 

Most households possess an ordinary bag or "fountain" 
syringe. Having various nozzles, most things may be done 
^^^th it. Scald the nozzle selected before using, as contagious 
ailments are sometimes communicated by reason of persons 
making unauthorized use of another person's syringe. 

Besides the bag syringe, a hard-rubber piston sj^ringe, to 
hold six ounces, is useful in the nursery. Better yet, per- 
haps, is the ordinary bulb syringe, with a soft-rubber nozzle. 
The latter can be easily made extemporaneously from a piece 
of small rubber tubing slipped over the hard nozzle. For 
high enemas, a soft-rubber catheter is used, but as it is likely 
to spoil if kept without using it would better be bought when 
required. 

FOR SURGICAL NEEDS 

For the surgical emergencies described, the following things 
are convenient : 

A pair of tweezers, preferably strong enough to hold 
tightly to whatever they may grasp, also with rather fine 



184 THE CENTURY BOOK FOR MOTHERS 

points, so that they may grasp splinters under the nails or 
other things in cramped situations. 

Absorbent cotton. 

Gauze or old linen. 

These articles should be done up into small packages, so 
that they may be kept clean until required. They may be 
bought in such parcels. Gauze can be easily and cheaply 
made from cheese-cloth, which is boiled and dried, cut up into 
yard lengths and then folded into bundles which will go into 
an ordinary preserving- jar. Put each piece into a jar with 
the cover loosely on, place it in a slow oven and heat, stop- 
ping if signs of browning appear. Fasten the cover of the 
jar, and the gauze will be clean until used. Cotton or old 
linen may be made sterile in the same way. 

Bandages may be made of gauze, linen, or cotton; the 
first is cheapest and best. They may be bought, if preferred. 
They should be of different widths, from one inch wide for 
children's hands to two and one half inches for their limbs. 
For adults, still wider ones are used. They should be rolled 
up firmly into cylinders. The lengths for the nursery should 
be from one to two yards. 

For adjusting wounds nicely isinglass plaster is best. It 
adheres by moistening. Never wet the plaster for a wound 
in the mouth. Take a small Avad of absorbent cotton or 
gauze, wring it out of boiled water or boiled water contain- 
ing salt or some other antiseptic. Moisten the plaster with 
this wad. 

When a more retentive dressing is needed, the rubber plas- 
ter now so generally sold on spools is most convenient. It 
adheres without warming. Half an inch is a convenient 
width for nursery use. A similar plaster, containing zinc 
oxide, is in use for irritable skins. 

The wads of cotton or gauze just alluded to have displaced 
sponges for cleansing wounds in domestic surgery. They 
are more certain to be clean, and are thrown aside as used. 

A one-ounce vial of collodion, with a camel's-hair brush 
fixed in the stopper, is very convenient for covering scratches, 



THE HOUSEHOLD PHARMACY 185 

etc., after they have been cleansed. A finger should be kept 
over the mouth of the vial whenever the stopper is out, as 
the ether of the collodion rapidly evaporates and leaves a 
hard unmanageable mass behind. 

Vaseline or cosmoline has become a household convenience. 
For the dressing of wounds, it is best bought in tubes with 
screw caps, like an artist's colors, as that not used is thus 
more readily kept clean. A\Tien needed the vaseline is 
squeezed out. 

DISINFECTANTS 

It is doubtful if the more poisonous antiseptics should be 
kept in the house, except during the time of their constant 
use. Boric acid, used in the form of a saturated solution, 
alcohol, and a solution of common salt in boiled water, a 
heaping teaspoonful to a pint, serve for most nursery sur- 
gery. The boric acid should be plainly marked, as it is some- 
times mistaken for milk-sugar. But this rule of plain label- 
ing must be applied to every remedy. 

Oiled silk or thin rubber is convenient for covering dress- 
ings of all sorts. If these are used and it be desired to 
keep them for further use, they must be placed in boiling 
water for disinfection before they are put away. 

Whenever an instrument or a basin is to be used, it should 
be made clean by heat. Instruments of steel are to be boiled, 
a little bicarbonate of soda being put into the water to pre- 
vent rusting. An agate or metal basin can be exposed to a 
still higher heat than that of an oven, as it has no temper to 
be considered, as has the steel instrument. 

MEDICINES 

The medicines to be kept in the nursery pharmacy need 
not be many. To begin with, a good many of them are 
found in the kitchen or pantry, and may as well remain there 
until needed. Thus, alcohol is often in use for the spirit 
lamp. Whisky or some similar stimulant is more likely to 



186 THE CENTURY BOOK FOR MOTHERS 

be in the house than is necessary. The coarse preparations 
of ammonia now very generally used in the household wall 
serve perfectly well as a stimulant to the nostrils, but not 
for internal use. 

Bicai-honate of soda (baking soda) is pretty certain to be 
in the kitchen. It is useful as an application to burns and 
as an antidote to acids swallowed. 

Olive oil is useful as an external application, especially 
for burns, as a lubricant, as an ingredient of enemas, and 
as a remedy, after vomiting has been produced, for almost 
all poisoning from irritating substances. 

Salt and mustard are among the best of prompt emetics. 
The salt may be dissolved in water in almost any proportion. 
It also, if added to an enema, increases its activity. Its use 
as a disinfectant has just been described. Mustard as an 
emetic is very prompt. An adult may take a tablespoonful 
of dry mustard, if mixed with an equal amount of molasses 
and a glass of water. The object of the molasses is to insure 
complete mixture. In the nursery, a teaspoonful would be 
enough. Soap-suds also furnish a useful emetic. 

Meal of any sort will furnish poultice material in an emer- 
gency. Turpentine, useful for stupes (see p. 156), is usually 
kept for cleaning. 

This considerable number of remedies being found among 
the household articles proportionately diminishes the number 
which need be kept in the medicine-closet. 

The list of medicines which may be used is a long one, but a 
very short one Avill contain all the drugs that would better 
be in a family medicine-closet. Medicines recommended by a 
physician for a particular child or for members of the fam- 
ily for whom they are suitable may be added from time to 
time, but should be labeled and kept track of by some method, 
as suggested on page 179. 

For general use in emergencies, there may be kept as 
cathartics castor-oil and triturates of calomel. The advan- 
tages of each, the methods of keeping and of administration, 
are mentioned on pages 159 and 165. 



THE HOUSEHOLD PHARMACY 187 



EMETICS 



For general use, the syrup of ipecac is best. It is safe, as 
it produces no harmful effects beyond the vomiting. It is 
especially applicable when, as in spasmodic croup, it is de- 
sired to produce a certain amount of relaxation from the 
preliminary nausea. The dose is from half a teaspoonful to 
a teaspoonful, according to the age of the child, repeated in 
twenty minutes if it has not sooner acted. For immediate 
production of vomiting, without nausea, mustard has already 
been recommended. Poivdered alum acts in the same man- 
ner. The dose is usually about a level teaspoonful mixed 
with syrup. Another use of the syrup of ipecac is as an 
expectorant— that is to say, to "loosen" the cough of laryn- 
gitis and bronchitis. The syrup can be mixed with water in 
such proportions that a teaspoonful of the mixture shall con- 
tain one or two drops of the syrup. This may be given by 
the teaspoonful every half hour, but the dosing must be 
stopped if nausea is manifested or if the symptoms are re- 
lieved. 

CARMINATIVES 

Carminatives are useful for the relief of colic. The most 
efficient and agreeable are the spirit of peppermint or of 
anise. Fifteen or twenty drops may be added to a tea- 
cupful of hot water, and the well-stirred mixture adminis- 
tered by spoonfuls to an infant. An older child may drink 
as much as it pleases from the cup. For colic due to acidity, 
an antacid is often useful. This is one of the uses of lime- 
water. Another useful antacid is the bicarbonate of soda. 
This compressed into tablet form, with the addition of pep- 
permint, constitutes the soda-mints of the shops. They are 
quite convenient for ordinary emergencies. If they are to 
be used they should be bought fresh— i. e., with a strong 
odor of peppermint— and kept in a tightly corked, wide- 
mouthed vial. 



188 THE CENTURY BOOK FOR MOTHERS 



REMEDIES FOR FEVER 

For the relief of fever, the writer believes that the time- 
honored sweet spirits of nitre is safer and better for house- 
hold use than any other remedy. It has no depressing 
after-effects, such as make aconite and the popular coal-oil de- 
rivatives so unfit for domestic use. Besides promoting per- 
spiration, it calms nervous irritation and excites a flow of 
urine. For this last reason, it is much used when this excre- 
tion is scanty. The dose for a child would be five to ten 
drops, according to age, repeated hourly. A convenient way 
is to put half a teaspoonful or more into a glass of cool water 
and let the child, if above two years of age, drink from 
this glass, using the whole, if he chooses, in the course of 
two hours. Keep the mixture covered in the intervals of 
drinking. The medicine itself should be kept in a small 
vial, as nearly full as convenient, tightly corked, and away 
from the light. 

BROMIDES 

Another soother of nervous irritability is one of the alka- 
line bromides. The bromide or sodium suits the stomach 
better than the potassium salt. It can be had in tablet form, 
each tablet generally containing ten grains. An infant of 
six months would better make four or five doses of one tablet. 
The tablet can be dissolved in water, and the proportionate 
part given. Older children can take larger doses. This 
drug is not, however, to be given carelessly. 



OPIUM PREPARATIONS 

For the relief of pain, no drug is so efficient as opium, 
but it is badly borne by children. For nursery use, the only 
preparation admissible— if any be— is the paregoric elixir. 
It contains opium in the proportion of one to two hundred 
and fifty parts. It also contains camphor and anise, so 
that its soothing effect is out of proportion to its opium 



THE HOUSEHOLD PHARMACY 189 

strength. An infant should have no more than five to ten 
drops. It is customary to print directions upon the label. 
While its action in emergencies and under proper restric- 
tions is very pleasant, its frequent and indiscriminate em- 
ployment is only to be condemned. 

VARIOUS ANTIDOTES 

When speaking of accidental poisoning, a number of anti- 
dotes pretty certain to be in the house were mentioned. For 
dwellers in towns it is useless to provide any others. But 
by those living remote from a pharmacy, two or three may 
be found useful, if only from the sense of security they give. 
These are : Tannic acid, to be used as an antidote for the 
various poisonous plants and mushrooms which omnivorous 
children may eat (see p. 181). It would better be kept in 
powders of five grains each. In case of poisoning, give one 
or two powders, according to the child's age, dissolved in 
water; repeat every quarter of an hour for several doses. 
The emetic, of course, is used first. 

Epsom salts (see p. 180) is believed to be the best antidote 
for carbolic acid. Dissolve a tablespoonful of the salt in a 
tumbler of water. Give as much as the child will take. It 
may be repeated, as the over-effect of the salt is trifling com- 
pared with that of the carbolic acid. 

Sulphate of copper (see p. 180), or blue stone, is recom- 
mended as the best emetic for phosphorus (matches) poison- 
ing, because of its having the additional effect of being an 
antidote. This effect has been disputed, but its emetic power 
is unquestioned. The emetic dose for a child is one or two 
grains, and powders or tablets of one grain each make a con- 
venient form for keeping the drug. 



PART II 
QUESTIONS AND ANSWERS 



I 

MINOR AILMENTS AND TROUBLES 

THE CAUSES AND TREATMENT OF COLIC 

What is the cause of colic? 
Can anything be done to prevent it? 

How can a child be relieved when suffering from an attack of 
colic ? 

Colic generally means a painful affection of the intestines, 
but the name, with certain qualifying adjectives, is ap- 
plied to other painful troubles. There is, besides the pain, 
sometimes more or less spasm of the bowels. The causes, as 
far as applied to infants or young children, are usually con- 
nected with the digestive process, such as indigestion from 
improper or excessive food or drinks, constipation, fermen- 
tation of food— producing gas, etc. Besides, we may men- 
tion chilling, cold feet, etc. 

Watching for the dietetic error which causes the pain and 
avoiding the repetition of the cause are usually effective. 
If the child has a feeble digestion it will be necessary to im- 
prove, if possible, the digestive power, and to suit the food 
to the enfeebled power while it exists, and, in like manner, 
to remove as far as possible any recognized tendency or as- 
signable exciting cause. It is true that some children dur- 
ing the first months of life show a tendency to colic for which 
an adequate cause cannot be easily discovered. But these 
cases are relatively rare. 

13 193 



194 THE CENTURY BOOK FOR MOTHERS 

The usual simple and effectual remedies are the follow- 
ing: Heat to the feet and bowels; the heat should be as 
great as can comfortably be borne, but short, of course, of a 
degree that would damage the skin. If there be gas in the 
stomach or bowels, a change of position, such as putting the 
child stomach downward on the hot application, together 
with rubbing of the abdomen front and back, often seems to 
favor the escape of the gas, with relief of the pain. If the 
gas be in the lower bowel it may escape if a soft tube, such 
as a large catheter, be passed into the bowel. So also a warm 
enema may aid the expulsion of the gas. Internally, hot 
water, either alone or with carminatives, such as a few drops 
of peppermint or anise cordial, or gin, or brandy, or, best of 
all, although disagreeable in smell, tincture of asafetida will 
be found useful. This latter may be given by the mouth or 
injected into the bowels. If the pain is severe, small doses 
of paregoric— proportioned to the age of the child— may be 
given. 

COLIC AND TEETHING 

Will cutting the lateral incisors give a baby colic? It seems to 
in the case of my baby, ten m.onths old. I give her capsicum 
tablets for it. Is there anything better that you can recom- 
mend ? 

The cutting of teeth is charged with many digestive disor- 
ders. The latter are, however, now attributed, by those 
giving attention to such things, more frequently to changes 
in the development of the digestive organs which occur at 
the same period as teething. It is, therefore, safer to say that 
such symptoms accompany rather than depend upon teeth- 
ing. Capsicum, the oils of mint and anise, in the shape of 
cordials, or the tincture of the drug-shops— a few drops in 
hot Avater— and many other things will relieve colic. Hot 
water alone is often efficient. Better is it, if possible, to 
remove the cause. 



MINOR AILiVIENTS AND TROUBLES 195 



COLIC ACCOMPANYING NURSING 

What is the cause of my baby girl, two and a half months old, 
having colic when she nurses? She may have been perfectly 
quiet before she began, and oftentimes will only take one or 
two swallows when the colic strikes her, and it is only by 
working with her for some time that she can get enough to 
satisfy her. The only time that she is not troubled is when 
she takes her one night nursiag. 

Two physicians have given her simple remedies for indigestion, 
but they have had no effect; others said the milk came too 
fast, but the above sentence disproves that, as naturally at 
night it comes faster than at any other time. Can you tell 
me what the cause is ? She sometimes sleeps the whole morn- 
ing, and anyway is nursed only every two and three quarter 
hours, yet always has it. Have you ever had a similar case? 
I have not met any one that had ever heard of it. I am not 
alarmed about it, but I should like to know of something to 
relieve her at that time when she ought certainly to be easy. 
She is not one bit sick, but, on the contrary, is thriving nicely. 

Such cases are by no means rare in infancy or in later 
childhood— that is to say, the taking of food into the stom- 
ach excites prematurely the stomach and intestines to action. 
We do not know enough of your condition of health or of 
your baby's to tell you what is the exact cause in this case. 
Sometimes the trouble is due to over-irritability of the diges- 
tive tract in the child, sometimes to some unsuitableness of 
the food— milk, or whatever it may be. In older children, 
as well as in infants, it is not rare to see a meal— whether 
from breast, bottle, or from table— frequently or even usu- 
ally interrupted b}^ a movement of the bowels. Doubtless 
your baby's case belongs to the same group, although the 
effect seems to be limited to colicky pain. The fact that 
the disturbance is less marked at night does not quite clear 
up the matter, because your milk might be better for your 
rest, or baby's digestion better for her rest. Take one of 
your two physicians and let him follow out the matter. 



196 THE CENTURY BOOK FOR MOTHERS 



"THREE-MONTHS' COLIC" 

Please tell me something about the legitimate remedies for 
"three-months' colic" in infants. I am entirely without ex- 
perience, and, with the advice of nurses, friends, and doctors, 
have rung the changes on "carminatives" — catnip-tea, soda- 
mint, gin and fennel, etc. Are these all harmful? 

Catnip-tea, given hot, and soda-mint, dissolved in hot water, 
are both safe and useful in relieving colic; but it is best 
to search for causes. Children have colic at all ages. It 
is, perhaps, more frequent at the age mentioned than ear- 
lier, because the little one ha^ gained more independence 
of action, kicks its covers off and so gets chilled, and is in 
warm climates or seasons often placed upon the floor. Be- 
sides—and perhaps this is most important of all— certain 
processes of development in the intestinal canal make the 
child at this age more susceptible to derangement from all 
causes. A child that has shown the colicky tendency should 
be carefully protected about the bowels at all times; should 
not be allowed to become constipated ; if fed, should have its 
food prepared with great circumspection; if suckled, its 
mouth and the nipple should be kept particularly clean to 
avoid any source of fermentation which might act upon the 
milk. 

CURE FOR COLD HANDS 

Can you tell me why my little boy of ten months has almost 
always cold hands? He seems to be in good health otherwise. 

The commonest causes of cold hands in little children are 
poor nutrition, feeble circulation, or undue perspiration. 
The cure must lie in the improvement of the nutrition and 
tone, but some help may come from the addition of salt to 
the daily bath, and the sponging of the body, rather than its 
immersion in water. 



MINOR AILMENTS AND TROUBLES 197 



COLD FEET AS A CONSEQUENCE OF SHORT CLOTHES 

Can you tell me how to keep my little girl's feet warm through 
the day? She is eight months old, has always been strong 
and well, is plump, and has rosy cheeks. I put her into short 
clothes a month ago, putting on long woolen stockings and the 
little soft, solid shoes that come for the first wearing. At 
night, when I undress her, her little feet are very cold and 
clammy. 

It is not very easy to keep quite warm the feet of a baby who 
is short-eoatecl in winter. The first effect of shoes is rather 
to retard the circulation in the feet by diminishing the play 
of the muscles. Little ones who are very vigorous often 
liave the feet and hands considerably colder than the body 
or the limbs. The best way we know is to have the shoes 
and stockings very large, to make sure that the feet are 
quite warm when put into their coverings, and if this alone 
does not succeed, to take off the shoes and stockings in the 
middle of the day, rub and warm the feet, and reclothe them. 
See also that the napkins are not so tight as to prevent exer- 
cise of the limbs. 

PERSPIRING FEET 

My little girl, aged four, perfectly healthy apparently, has each 
night her stockings and shoes damp with perspiration. I am 
sure it cannot be because her feet are too warm, for our home 
is in the country and the floors are not over-warm. Can you 
suggest the cause and cure? Though she never complains, it 
would seem as if her feet must be cold from the dampness. 

Perspiration of the feet is sometimes a personal peculiarity, 
the cause of which is not easy to discover, or is practically 
impossible to remove. But as a common cause is an imper- 
fect circulation, it is always well to search for anything that 
may retard the flow of blood from the feet. See if the stock- 
ings and shoes are wide and easy; if there is any undue 



198 THE CENTURY BOOK FOR MOTHERS 

tightness at the knee, etc. Watch if the palms also perspire 
when covered by mittens ; if so, it will show that the peculi- 
arity is a general one, and not confined to the feet. It may 
be noted that people of the '' rheumatic" habit are thought 
to perspire more than others. 

ENLARGEMENT OF GLANDS 

My baby has a kernel about the size of a small bird's egg on the 
left side of her neck, also two behind each ear the size of peas. 
The kernels have been there two months. Can you tell me if 
that is anything serious? She is thirteen months, has six 
teeth, and is a healthy baby; although she looks delicate, she 
is very bright, walks and talks. 

The kernels are enlarged lymphatic glands. Their enlarge- 
ment has come from an irritation elsewhere, such as en- 
larged or inflamed tonsils, some eruption, scratches, or what 
not. The glandular enlargements often persist long after 
the trouble which gave rise to them has been forgotten. They 
are probably not serious. Sometimes they gather, or have 
to be removed, but in the great majority of cases the glands 
return to their natural size with the disappearance of the 
exciting cause. 

PROBABLE CAUSE OF MOUTH-BREATHING 

Will you kindly tell me how I can break my little baby, two 
months old, of the habit of sleeping with his mouth open? It 
seems to me advisable to stop his doing so at once. 

Inasmuch as the habit of sleeping with the mouth open is 
usually due to obstructions in the nasal passages, it is very 
difficult to break up the habit until the obstruction is re- 
moved. In older children the usual obstruction is from an 
adenoid growth in the back of the nose (pharynx). But in 
a very young baby this is probably not the case. Look into 
the throat to see if the tonsils are large. Examine the nos- 



MINOR AILMENTS AND TROUBLES 199 

trils to see if they be wide enough, or choked with mucus. 
If you cannot find a cause, ask your physician. 



ENLARGED UVULA 

I am prompted to ask your advice concerning what seems to be 
a chronic enlargement of the uvula and soft palate in my 
little four-and-a-half-year-old son. To this enlargement our 
local physician attributes the child's inability to speak plainly 
and his difficult breathing at night. But this same physician 
assures me the child will outgrow the trouble. The boy is a 
strong, sturdy child, weighing forty-six pounds, and of good 
height, thoroughly healthy, so far as I know. But the slight- 
est cold settles immediately in the uvula, causing the child 
untold trouble as soon as he lies down, with an almost constant 
throat-cough, which very often results in nausea. His breath- 
ing at night is always impeded; his mouth is, at night, usu- 
ally open, and he snores very audibly. iVltogether the symp- 
toms are to me distressing, and I turn to you for advice as to 
what should be done, since it seems to me a case which should 
not be left for the child to outgrow, if, indeed, he ever may. 

We should advise, first, the examination of the pharynx to 
see if there is also an obstruction there besides the enlarged 
uvula. If there is, the cause of the obstruction Avould much 
better be removed. If the pharynx is clear, then we think 
such a uvula as you describe, which is sufficiently enlarged 
to impede breathing, should be cut off, even if in time it 
would shrink, for the boy will suffer damage in the meantime. 



PATCHES ON THE TONGUE 

For a year past I have noticed in regard to my little boy, who is 
now two years of age, that the tongue is very often covered 
here and there with small white patches. Sometimes they are 
red in the center with a white rim. The child has always 
been very pale, but, with that exception, has seemed very well 
and full of life, scarcely ever having suffered from even a 



200 THE CENTURY BOOK FOR MOTHERS 

cold. He weighs thirty pounds, and his flesh is firm and solid. 
He enjoys a good appetite, and I have always tried to be care- 
ful concerning his diet. He takes cereals for breakfast at 
8 A.M., and nearly always calls for a second saucerful, seldom 
taking anything else, except a cup of milk and an oaten flake- 
cracker. Occasionally he will eat the yolk of a soft-boiled 
egg with bread for a change, and he is fond of apple-sauce, 
but generally takes what I first mentioned. 

Until within a couple of months he took a lunch of oatmeal 
crackers and milk at eleven, and his dinner at two. He has 
now dispensed with the lunch and takes his dinner at one, 
eating a plate of chicken, beef, or mutton broth, with rice, 
bread and butter, and a cup of milk. He varies this with 
cream toast or bread and butter and a little beef, mutton, or 
chicken cut up fine, but eats very few vegetables, almost none. 
He likes plain rice pudding, junket, or custards, which I occa- 
sionally give him for dessert. He tak'es his supper at 5:45, 
of a couple of slices of bread crumbed in warm milk, after 
which he is off to bed, and is a good sleeper. He never asks 
for anything between meals, though I have given him an apple 
at times, which he has seemed to enjoy. I peeled it and cut it 
in small pieces. It did not seem to hurt him, though I thought 
it best to ask your advice before continuing it. 

Can you enlighten me in regard to the patches on the tongue — 
the cause, and what to do to overcome the trouble? 

In all probability the patches are those of common sprue, 
although the child is rather old to have this disorder. The 
real cause is a microscopic plant akin to the yeast-plant. It 
may be acquired from the air at any time, but some con- 
ditions not those of perfect health seem necessary to its 
growth, the chief of which is acidity of the secretions of the 
mouth from any cause. Sweet food, starchy food, the re- 
mains of milk, etc., may ferment in the mouth and give the 
requisite condition for the development Prevention is best 
secured by being careful about sweets and cleansing the 
mouth after eating, using an alkali to secure alkalinity of 
the mouth. Lime-water Avill do, but a favorite one is borax, 
which unites with slight alkalinity the disinfecting power 



MINOR AILMENTS AND TROUBLES 201 

of the boric acid. A solution of borax with a little extra 
boric acid added is very good— say, dissolve a heaped tea- 
spoonful of powdered borax in a teacupful of water, then 
add half a teaspoonful of boric acid and stir until the 
whole, or as much as possible, is dissolved. First clean off 
the spots as well as you can with a soft rag over the tip of 
your finger. Then wash the tongue well with a rag dipped 
in the solution. The latter is better if you add to it a des- 
sertspoonful of glycerin. If the mouth is kept alkaline, as it 
naturally is, the plant will hardly grow. Of course, the 
kinds of food likely to favor the growth should be restricted 
during the presence of the growth— that is to say, starchy or 
sweet foods. 

There seems to be nothing out of the way in the diet if the 
digestion is adequate, and you do not speak of anything to 
the contrary. There are few fruits which are distinctly use- 
ful except when fresh, although many are admissible. So 
of vegetables ; there are very few, we think, which are really 
advantageous at two years of age. Yet some children can 
bear them without evident indigestion. The parent usually 
thinks of a dietary as containing all the things that can be 
given without positive and immediately recognizable harm; 
the medical adviser, on the other hand, thinks of a dietary 
as made up of articles really desirable as food, and some 
innocent indulgences to tempt the palate. Between these 
plans a good deal of room for judgment is left, and the best 
of this judgment lies in the application of general rules to 
the particular case. Our own inclination is always to give 
rather less than the digestion could carry— that is, to leave 
a little reserve digestive power. 



COATED TONGUE 

My two little girls have always been very healthy children, nei- 
ther having had even the common eruptions or rashes inciden- 
tal to infancy; but the elder, three and a half years old, has 
always had a white-coated tongue, except at very rare inter- 



202 THE CENTUEY BOOK FOR MOTHERS 

vals. She is the picture of fair, robust, rosy childhood, per- 
fectly sound in every way apparently. Can you account for 
this seemingly incongruous case? I sometimes feel anxious 
about it, as such a tongue is usually regarded as indicating 
a disordered stomach; but this cannot be so, as I am and al- 
ways have been particular as to food, regular hours and 
habits, clothing, etc., which are such as I think you would 
approve of. 

We cannot, of course, tell why the child's tongue is white. 
It is noticeable in some children and adults without any 
corresponding symptoms of stomach disorder. And we have 
noticed that some persons, when using a milk diet, even if 
with pleasure and apparent benefit, have a slight whitish 
coat or coloration upon the tongue. If you can find no other 
evidence of ill health, we think you may safely disregard 
the symptom. 

THE PREVALENCE OF "SORE MOUTH" 

Is sore mouth ever epidemic among young babies? A great 
many have had it in the locality where I live. 

The difficulty of answering this question lies in its vague- 
ness, the writer apparently supposing that sore mouth in 
children is always the same thing. There is, first of all, the 
catarrhal sore mouth, which is sometimes associated with 
teething or with any irritation of the mouth, and which has 
been known to follow so slight a cause as crying or too long 
use of the voice. The kinds of sore mouth that are some- 
times very prevalent are the aphthous variety, popularly the 
''sprue," which is often seen in infants with disordered di- 
gestion or those who are somewhat debilitated. Under local 
depressing circumstances, such as dampness or unwholesome 
situation of the house, the disease may be very prevalent. 
Another form— popularly ''thrush "—is due to the presence of 
a parasitic growth, and this may be propagated by contagion, 
as in passing a nursing-bottle from one mouth to another. 



MINOR AILMENTS AND TROUBLES 203 



THE CAUSES OF SORE MOUTH 

• 
My baby is troubled with a very sore mouth, which is exceed- 
ingly painful when she drinks. I have heard of bottle babies 
suffering thus for months, the ulcers often leaving scars for 
years. Is this the common fate of all poor babies who must 
nurse from a bottle, and is there no preventive or cure? It 
seems to be a rubber poison. I have read of silver and por- 
celain nipples, but have been unable to find any. Do you 
know where such articles can be purchased? 

It is not the "common fate" of bottle babies. Some babies 
who are feeble get sore mouths, whether on the bottle or 
the breast. The commonest cause of sore mouths is neglect 
of the details of tidiness. The rubber nipples should be 
carefully scrubbed and cleaned, and such cleansing would 
be just as necessary if you had metal, porcelain, or even 
glass nipples. Besides, the child's mouth should be cleansed 
before nursing, and quite thoroughly after nursing if a ten- 
dency to sore mouth exists. Ordinary borax or boric-acid 
solutions are good, but others are used, according to the con- 
dition of the mouth, as directed by the physician. Metal 
and porcelain nipples are objectionable, especially the metal, 
even if they can be obtained. We have not seen one in a 
great while. The old ivory mouth-piece, too, has gone into 
deserved retirement. Rubber nipples of good quality, if 
properly cared for, will give you little trouble, we think. 



SWOLLEN TONSILS 

My little boy, who is just four years old, is troubled with swol- 
len tonsils. During sleep he snores distressingly, and he has 
frequent colds in the head. Our physician thinks it would be 
best to cut the tonsils, but I dread the operation, and many 
friends, some of them experienced mothers, warn me against 
allowing the operation to be performed. They tell me that he 
may outgrow the trouble; that the operation, performed at this 
early age, might have to be repeated, and that, as he is the 



204 THE CENTURY BOOK FOR MOTHERS 

picture of rosy health, the swollen tonsils and labored breath- 
ing at night cannot be doing him any injury. I am very 
much troubled about the matter, and am anxious to have your 
advice. Does this condition of the throat predispose to diph- 
theria? What home treatment would you suggest to diminish 
the swelling? 

Of course, it is impossible for us to give a decided opinion 
as to this particular case; but, in a general way, something 
may be said. Even if the phrase "swollen tonsils" be lim- 
ited in meaning to express only a condition of some dura- 
tion, it does not always mean the same thing. In health the 
tonsil is very small— so small that some who have studied 
throat diseases particularly think that it does not exist in 
the sense of being a visible prominence. Now, when the 
tonsil becomes enlarged and remains so, it may be from 
removable causes and conditions, or it may not. Stripped 
of all technicality, the one group of cases may be consid- 
ered as those in w^hieh much of the enlargement is due to 
an excess of blood in the tissues, and the other group em- 
braces cases in which actual overgrowth of the tonsil has 
occurred. In the former cases the enlargement may dimin- 
ish until the tonsil, while still larger than proper, gives no 
very great trouble. In the latter, the most experienced ob- 
servers doubt if any treatment short of removal of the tonsil 
by some means is of much value. The popular ideas about 
outgrowing the condition are based partly upon the false 
assumption that Avhat is really a considerably enlarged ton- 
sil is the natural state of things, and partly upon the in- 
ability of non-professional observers to distinguish between 
the temporary swelling of the tonsils, the chronically en- 
gorged tonsils, and the really overgrown tonsils. Now, the 
opinion of the most "experienced mother" can be of no 
value here. She cannot, at the outside, have seen more than 
two or three cases of the last-mentioned variety. It is fair 
to presume that if you have a family physician you have 
chosen him because you believe him to be skilful and con- 



MINOR AILMENTS AND TROUBLES 205 

scientious. That being the case, it is probable that such a 
man would not advise cutting off the tonsils if he believed 
he could accomplish a cure by any less severe method. If 
you are not content to rely on his judgment alone, get that 
of another physician, but do not ask or accept lay advice. 
So much for the "outgrowing" of the disease. As to the 
need of repeating the operation, only this need be said: 
The operator does not undertake to put the patient into better 
health than he had before the disease began. It is very 
common to find people who suppose that after an operation 
they can with impunity follow the same faulty course of life 
that originally caused the disease for which the operation 
was made. If the tonsils are removed the same care must 
be observed to prevent ncAv trouble as would be requisite to 
cure the enlargement if it were of the kind curable without 
operation. As a matter of experience, however, it is true 
that if the tonsil is thoroughly removed at first a second 
operation is rarely, if ever, required. "Outgrowing" the 
disease is a bad name, since it conveys the idea that the 
simple lapse of time and increase of stature are sufficient 
for the purpose. This is only the case when improved health 
comes with the lapse of time. And in this disease this im- 
provement is the result of very persistent watching as to all 
the details of hygiene, local and general, in the widest sense 
of the word. 

This may sound strange as applied to one who is the 
"picture of rosy health," but we have so often heard this 
epithet applied to children who did not at all correspond to 
a physician's idea of health— indeed, have so often been 
asked to admire the very evidences of disease— that we are 
obliged to disregard such general statements. 

While there is every reason to suppose that diphtheria 
is due to a special poison, it is also true (to quote from a well- 
known authority) that "any abnormal state of the mucous 
membrane . . . affords an excellent abode for diph- 
theria." The home treatment is suggested in what has al- 
ready been said regarding hygiene. 



206 THE CENTURY BOOK FOR MOTHERS 

ROUGHNESS OF THE VOICE 

I have for some time been worried about my boy of six months. 
Ever since he was a few months old I have noticed that his 
voice is rough, sometimes very little, at other times, and espe- 
cially after crying, so much so that he can hardly make a 
sound. My physician seemed to attach no importance to it, 
but it worries me to think that he might keep it, and I should 
like to ask what I might do for it, and if there is any danger 
of the voice remaining rough. The boy is otherwise perfectly 
well, never had any trouble, and is not yet teething. 

The roughness of the voice is probably due to some relaxa- 
tion of the vocal cords or some congestion of the mucous 
membrane. The latter explanation would more likely accord 
with the fact of the roughness coming after crying. As to 
the probable duration of this condition, we can give no opin- 
ion which would be more than a guess. 

BED-WETTING 

My little boy is nearly three years of age, and very healthy and 
strong, but he persists in wetting his bed nearly every night, 
despite punishment, restricted diet, etc. I know positively the 
trouble is not due to phimosis. 

First of all, it should be remembered that the relative 
positions of a little child's bladder and urethra are different 
from what these will be later in its life, and that bed- wetting, 
even if very obstinate, usually is overcome ultimately, both 
by the real developmental changes and by the less sound 
sleep of later childhood. AYe think that bed- wetting in 
young children is never a subject for punishment. You say 
that you are sure that no phimosis exists. In connection 
with bed-wetting, this means that the foreskin cannot only 
be drawn back, but completely back, so that there are no 
adhesions or sources of irritation behind the ridge of the 
glands. But we accept your statement in full and leave this 
cause. In addition, you have tried restricted diet, which we 



MINOR AILMENTS AND TROUBLES 207 

suppose includes restricted liquids of all sorts near bed- 
time. After the local irritation of phimosis and the me- 
chanical distention of a bladder owing to liquids, one natu- 
rally thinks next of local irritations in the bowel from 
constipation or ^vorms ; next, of irritation of the bladder from 
urine too concentrated or containing irritating matters from 
a diet too rich in elements which go to make urates in the 
urine. Questions of too much or too little covering in bed 
have to be considered, and a variety of lesser causes, but 
those mentioned are the obvious and, we think, the more 
common ones. There is, however, always a considerable resi- 
due of cases which seem to be not dependent upon them, or 
at least not upon any one of them— cases, for instance, in 
which the sleep is so deep that many functions are performed 
unconsciously, others where there seems to be an unusual 
sensibility of the urinary organs. In the former group the 
best safeguard is the constant watching of the child and the 
taking it up at various times in the night before the blad- 
der has had time to fill to the danger point. For the latter 
type some drugs have proved very useful. But inasmuch as 
they (for instance, belladonna, which is one of the best) are 
mainly drugs of serious potency, their use ought to be espe- 
cially directed and carefully watched by a physician. 



BED-WETTING IN A NERVOUS CHILD 

My little boy of five still wets the bed every night. He is a very 
nervous child, and I do not want to resort to discipline in 
order to cure him of the habit. What is the cause of it, and 
what is the best treatment that you can suggest? 

''Discipline," in the sense of punishment, would be entirely 
out of place for a trouble of this kind, and, in the case of a 
nervous child, would be distinctly harmful. The bladder 
trouble is sometimes very obstinate, taxing the ingenuity of 
both parent and physician ; but, on the other hand, it some- 
times promptly yields to treatment. We presume the child 



208 THE CENTURY BOOK FOE MOTHERS 

does not waken, so as to give the mother a chance to place 
him on the vessel. The bladder is thus overfull— or fuller 
than it can tolerate— before he awakes. Such cases often 
occur, and often are cured by the systematic practice of 
waking the child at the hour of the parents' retiring, or later 
in the night, so that the bladder may be relieved. Of course, 
a nervous child should be wakened gently, so that it will 
not be frightened; but it should be sufficiently awakened to 
be conscious of the reason of its being taken up. Nervous 
children often manifest especial irritability of the bladder, 
and need systematic medicinal treatment. The management 
of this is too complicated an undertaking for domestic prac- 
tice, and cannot be entered upon here. If the habit of tak- 
ing up your little boy in the night, after limiting the amount 
of liquid taken before retiring, does not relieve him, ask the 
advice of the best physician within reach. The drugs needed 
are too potent for you to deal with without a physician's 
prescription and directions. 

THE CAUSE AND CURE OF HICCOUGH 

My baby, a little girl now seven and a half months old, has al- 
ways been troubled with hiccough. For the first three months 
her food was what nature provided; then that proved insuffi- 
cient, and the insufficiency was made good by cow's milk, 
upon which she has thrived. It is now her only food, and she 
is healthy, hearty, and happy, but is troubled very often with 
hiccoughs. She has them as often as four or five times some 
days, and perhaps next day will not have a single attack. She 
is now fed at intervals of four hours during the day, and gets 
one light meal at night. 

I have sought information of my nurse and of persons who have 
had large experience with children, and have received the uni- 
form, highly unsatisfactory reply: ''Babies who have hic- 
coughs always thrive." Can you throw some light on the 
probable cause and suggest a remedy? I have used liquor of 
pepsin, sugar and sweetened water (both warm and cold). 
They give only temporary relief. I would like to strike at 
the root of the matter. I hope your reply may help other 
inexperienced mothers. 



MINOR AILMENTS AND TROUBLES 209 

Hiccough is a spasmodic contraction of the diaphragm, which 
arises from a multitude of causes. AYhile in some diseases 
it is a grave symptom, it is usually only a passing annoy- 
ance, and of this type is common hiccough of babies. The 
real physiological reasons of hiccough are not well under- 
stood, but the exciting causes are. For babies the common- 
est causes are simple overfulness of the stomach or pressure 
upward of the stomach or abdominal organs from any cause 
(tossing the baby or a sudden motion from alarm may ex- 
cite it). AVhat the particular cause in any given case is, 
only a close observer of that case can tell. 

Some mothers have commented on the value of crying as 
a remedy. Recently in several medical journals the fact 
that sneezing is a cure has been discussed. The explanation 
of both seems to be this : Hiccough is a disturbance of the 
ordinary respiratory movements; so is sneezing and so is 
crying. If the one disturbance comes on, the other ceases. 
Every one must have noticed the similarity between hic- 
cough and the violent sobs following a hard fit of crying 
with some children. It is not necessary that a person actu- 
ally sneeze to produce the desired effect ; tickling or gentle 
irritation of the nasal mucous membrane is usually enough 
to stop the hiccough. 

This remedy, it has been pointed out by Dr. Gibson, is 
as old as Hippocrates, who says : ' ' Sneezing occurring after 
hiccough removes the hiccough." Dr. Burnett, in a letter 
to the "Medical Record," says: 

"When devoting a leisure hour to Plato's 'Dialogues,' as 
translated by Jowett, I was struck by a passage in the Sym- 
posium which had never arrested my attention before. 
Translated by Jowett, it stands thus: 'When Pausanias came 
to a pause, Aristodemus said that the turn of Aristophanes 
was next, but that either he had eaten too much, or from 
some other cause he had the hiccough, and was obliged to 
change with Eryximachus, the physician, who was reclining 
on the couch below him. "Eryximachus," said he, "you 
ought either to stop my hiccough or to speak in my turn 
until I am better." "I will do both," said Eryximachus. 

14 



210 THE CENTURY BOOK FOR MOTHERS 

'^I will speak in your turn, and do you speak in mine; and 
while I am speaking, let me recommend you to hold your 
breath, and, if this fails, then to gargle with a little water; 
and if the hiccough still continues, tickle your nose with 
something and sneeze ; and if you sneeze once or twice, even 
the most violent hiccough is sure to go. In the meantime I 
will take your turn, and you shall take mine." "I will do 
as you prescribe," said Aristophanes; ''and now get on." ' 
"The hiccough was not cured by the first nor by the sec- 
ond remedy suggested by Eryximachus, but by the produc- 
tion of sneezing. The method of tickling the nostrils has 
been tested by us in cases of obstinate hiccough, and has been 
very successful. It is not necessary that the stimulus ap- 
plied to the nose be followed by sneezing ; the application of 
a gentle irritant to the nasal mucous membrane may be quite 
enough to put a stop to the hiccough, by diverting the ner- 
vous energy into other channels, although it may not be of 
sufficient power to induce sneezing." 



EXCESSIVE NOSEBLEEDING 

My baby, six months old, had a severe attack of "nosebleed." 
She woke from a sound sleep, and blood commenced flowing 
and continued for some ten minutes. Is such an occurrence 
a rare thing for an infant, or does it indicate some serious 
trouble? She was perfectly well before the attack, and seems 
so since. Can you suggest a way to stop the flow should it 
again occur? Our family doctor says he never knew of a 
similar case, and volunteers no opinion. 

It is an unusual case. If it recurs, the safest and quickest 
remedy we can suggest is syringing the nose with quite cold 
or with hot water. A hot solution of alum is also quite 
efficient— a teaspoonful of powdered alum to a pint of hot 
water. If it should again occur, however, the nose should 
be examined thoroughly to see if any local cause— a small 
sore or anything of the kind— exists. This is sometimes the 



MINOR AILMENTS AND TROUBLES 211 

case, and a little local treatment may save much bleeding, 
which is particularly desirable, as babies feel the loss of 
blood relatively more than adults. 



GRITTING THE TEETH AS A SYMPTOM OF WORMS 

My baby grits his teeth terribly when asleep at night. His 
grandmother and I have thought he had worms, and I have 
given him several enemas of strong salt and water, but I have 
seen nothing that looked to me like a worm. His seat has 
been broken out and has itched fearfully, and the enemas seem 
to have benefited both these troubles ; at least, they have disap- 
peared. Of late, baby's urine has looked rather greasy on the 
surface. He is apparently in perfect health, but has a very 
small appetite, and would starve before he would eat really 
proper food. Whether this be so or not, he seems to crave 
"grown-up" food and digests it perfectly. He is two years 
and eight months old, was nursed till sixteen months, and 
carefully fed till after two years. He has always been well 
and strong, but not very fat. Now he eats almost what we do, 
and is growing fat and rosy. The only trouble he has is this 
appearance (to me) of worms. Do you think we are right in 
our theory, and what do you recommend? 

Gritting the teeth in sleep is not necessarily, or even usu- 
ally, a sign of worms. It may proceed from any irrita- 
tion, very often in the digestive tract. If a child shows the 
condition of urine you describe, we should look for digestive 
derangement ; this, added to the eruption on the seat and the 
gritting aforesaid, make a strong probability that he is suf- 
fering, as might be expected of a child of his age who takes 
** grown-up" food. If he is put upon a proper diet, irre- 
spective of his notions, he will presently yield the point and 
eat what he can get. It is, however, cruel to expect a child 
who has been indulged in this respect to sit at the same 
table with you without demanding your diet. He ought to 
be fed before your meals, and by himself. 

We are often at a loss to guess what is the standard of 



212 THE CENTURY BOOK FOR MOTHERS 

perfect health used by many persons. Your child is so de- 
scribed. Yet you mention small and capricious appetite, 
disordered urine, a skin-eruption and disturbed sleep as the 
sources of your anxiety about him. 

THE SIGNS OF WORMS 

My little girl, aged three years and five months, was taken sick 
recently with severe vomiting and was very ill for days. She 
had very high fever and coughed a long time after recovering 
otherwise. She seemed to have some intestinal catarrh. 
Though free from the diarrhoea now, she complains constantly 
at meal-time, and occasionally between-times, of "stomach- 
ache." She has very dark circles under her eyes and is very 
unusually irritable. 

I am far from competent physicians, and therefore ask : Can I do 
anything special in the line of tonic treatment? Has she, per- 
haps, worms? In the beginning of her illness she passed one 
long worm. 

To distinguish the ordinary intestinal catarrh from that 
which accompanies intestinal parasites, in default of the 
ocular demonstration of the worms, is practically impossi- 
ble. Nor can one always say whether the worms are the 
cause of the catarrh, or the catarrhal condition renders the 
development of the parasite possible. This, too, even when 
the case is under observation, since the classical old- wives' 
signs of worms are really but symptoms of gastro-intestinal 
irritation. It is, therefore, impracticable to say anything 
definite about a case at a distance. But the previous exist- 
ence of worms, as demonstrated, makes it rather probable 
that, similar symptoms continuing, others may be in the 
canal. It would be entirely proper to give a safe vermifuge 
—such as two grains of santonine night and morning for a 
couple of days, to be followed by a laxative. If you have 
no drugs at hand, you may find that common salt, a well- 
known vermifuge in Oriental countries, will be sufficient in 
doses of ten grains given three or four times a day. The 



MINOR AILMENTS AND TROUBLES 213 

doses may be given, if preferred, by rather oversalting the 
food. It has the advantage in these doses of being a tonic 
to the digestion. AVe may add that cod-liver oil, by its tonic 
effect, tends indirectly to destroy worms. 



THE CAUSE OF PIN-WORMS 

Our baby is a year old, and has always been xevj well and 
strong. A few weeks ago, however, I found she was troubled 
with pin-worms. I used injections of aloes, and they soon 
disappeared, but after a few weeks returned, and under the 
same treatment she is free from them again. I would like to 
inquire the cause of these little pests, and if there is any way 
to get rid of them entirely. I had supposed worms were 
caused by improper food, but as baby had never taken any- 
thing besides breast milk, that idea was discarded. 

The cause of pin-worms is always the introduction into the 
body of worms or their eggs. The worms may crawl from 
one child to another, while the eggs are obtained in various 
ways. They may cling to the finger-nails of another child 
who has the worms and who has been scratching its seat; 
they may be upon articles which the baby has access to, and 
so on indefinitely. Dogs often are sources of infection, espe- 
cially if they are allowed to lick a child's face or mouth. 
We cannot, of course, tell the source of infection in the case 
of your baby. 

TREATMENT FOR PIN-WORMS 

Will you please tell me something of the symptoms of pin-worms, 
and remedies for this trouble? Is it very common, or is indi- 
gestion often wrongly called "worms"? 

You are right; indigestion is often mistaken for "worms," 
and that convenient word is made to cover a wide extent of 
ignorance. Intestinal worms, however, are not uncommon, 
and sometimes really are the cause of various symptoms of 



214 THE CENTURY BOOK FOR MOTHERS 

nervous or digestive disturbance. The worm which most com- 
monly disturbs sleep is the oxyiiris vermicularis, commonly 
called pin- worm, thread-worm, or seat- worm. By day these 
worms usually excite little disturbance, but at night, perhaps 
owing to the recumbency of the patient or the warmth of 
the bed, they create a severe itching and burning of the seat 
which may disturb or prevent sleep. In some excitable chil- 
dren marked nervous symptoms may ensue. 

The treatment consists of great personal tidiness and laxa- 
tives to carry off the worms. The itching is allayed by the 
removal of the worms from the seat, and this is usually 
most readily done by injections of soap-suds or of salt and 
water. Olive-oil injections are useful also. Unaffected chil- 
dren should not be allowed to sleep with affected ones, as 
the parasites may be communicated. 

PERSISTENT ITCHING OF THE NOSE 

Our little girl of fourteen weeks is terribly troubled with an 
itching nose. Can you suggest the cause or remedy? She is 
a plump, strong, and rosy-cheeked baby, and has never had 
anything but breast milk until two weeks ago; at that time 
she was very constipated, with curd in the passages, and the 
physician advised giving her two meals per day of Mellin's 
food. She has five meals, three hours apart; she does not 
nurse at night; the food now seems well digested, and she has 
one good passage a day. She often wakes crying and trying 
to rub her nose on the blanket, and when lying on her side 
will turn over on her little face and rub it back and forth on 
the pillow. Her face has had scratches nearly all over, given 
by the little fingers, aimed for the nose. As soon as it begins 
to itch badly she wants to nurse and will suck her fist with 
great gusto. The doctor thought it some kind of abdominal 
irritation and gave her medicine which does no perceptible 
good. He thinks her too young for worms. She has had this 
trouble ever since she was old enough to make any attempt to 
rub her nose, perhaps five or six weeks ago. Do you think it 
can be worms, and is she too young to take worm medicine? 
She "drools" a great deal and bites my fingers very hard when 



MINOR AILMENTS AND TROUBLES 215 

I wash her mouth, though there is no sign of teeth. I have 
tried every way I could think of to chafe her nose, using my 
hand, a coarse towel, her hair-brush, etc. 

It would be well first of all to see if there is anything in 
the child's apparel that might cause the itching. Some 
fabrics, as, for instance, the " squirrel's-f ur " yarn, have a 
light nap, which is easily detached, and excites, by being 
inhaled, great irritation of the nose. Still in this case, if we 
must hazard an opinion, the trouble is probably due, as the 
physician suggested, to some "abdominal irritation." The 
presence of worms is not probable, and we may say that the 
itching of the nose, which is so often pointed out as a symp- 
tom of worms, is due, we believe, not to the presence of the 
worms themselves, but to the co-existing intestinal disor- 
ders. As to treatment, we would suggest that the chafing 
of the nose be done as little as possible, but that soothing 
applications be used. Very weak solutions of carbolic acid 
have been found useful ; so, too, have solutions of bicarbon- 
ate of soda, and many other things which your physician 
can suggest. Above all, persist in your attempts to discover 
the digestive disorder which probably lies behind the irri- 
tation described. 



WHAT TO DO FOR AN ATTACK OF FALSE CROUP 

I should like to ask what to do for my baby when she wakes up 
at night with a cough like the bark of the croup. What do 
you consider to be the best and quickest remedy until the doc- 
tor can be summoned in the morning? 

Where only the bark is present, often, and indeed usually, 
nothing is necessary to dislodge the mucus from the throat 
beyond the waking and the child's natural cry. If this is 
not sufficient, the drinking of a glass of milk (or even water), 
as hot as can be swallowed comfortably, or the placing of a 
sponge wrung out of hot water— as hot as can be borne by 



216 THE CENTURY BOOK FOR MOTHERS 

the child— upon the throat, will usually relieve it. It is, 
however, well to have in the house an emetic, and that which 
combines tolerable rapidity with the requisite safety is the 
syrup or wine of ipecac. If there is difficulty of breathing, 
from half a teaspoonful to a teaspoonful may be given, and 
repeated in twenty minutes if relief is not gained. If vom- 
iting is not required, doses of from two to five drops may be 
given hourly or less frequently, according to the severity of 
the cough. 

You should bear in mind that if nausea is produced, either 
with or without vomiting, it is likely to be manifested by 
paleness, clammy skin, and some perspiration, just as in 
adults. If this was not remembered, undue anxiety might 
be felt previous to the vomiting. 

THE TREATMENT OF BUMPS 

My little boy, two and a half years old, recently fell and arose 
with a big lump on his forehead. In my absence a neighbor 
pressed the swelling down with the blade of a kitchen knife, 
which achieved its object by reducing the lump, but left the 
spot quite tender and discolored. I know that this way of 
treating a bump is common in certain parts of the country, but 
supposed it had been generally superseded by more enlightened 
methods. Is there ever any danger in this procedure, and 
what do you recommend in similar cases? 

The method has no real harmfulness. The bump doubtless 
was caused simply by an effusion of blood from very small 
blood-vessels which had been broken, together with some effu- 
sion of the watery part of the blood (serum) into the loose 
connective tissue. Pressure will cause absorption of the lat- 
ter, but the discoloration from the effused blood will usually 
remain, just as after any bruise. The tenderness also is the 
rule. Treatment is simple. There is no special virtue in the 
table-knife (or a variety of other things used for the same 
purpose) , except that it is convenient for pressure and is cold. 
Witness the ancient remedy of the door-key, when this was a 



MINOR AILMENTS AND TROUBLES 217 

large implement of iron, applied to the back of the neck to 
arrest nosebleed. 

A rather ''more enlightened method" is to apply to the 
bump or bruise, by means of a sponge or cloth, water as hot 
as can be borne, gently pressing it. It does all that the cold 
pressure can do, and is more effective in relieving the pres- 
ent and preventing the subsequent tenderness. 



DROWSINESS FOLLOWING A BUMP ON THE HEAD 

What should I do when a child falls on the back of his head? 
Should I let him sleep or keep him awake? My little boy fell 
from his high chair a short time ago, hitting the back of his 
head with such force as to cause him to vomit. I was advised 
to let him go to sleep and send for a doctor, which I did; but 
baby woke up after an hour's sleep quite bright. My physi- 
cian says I should have kept him awake, but I think I did 
right. 

What harm can it do to a child to sleep right after having had 
such a fall? 

We also think you did right. We do not know of any con- 
dition due to an injury where keeping the child awake can 
do any good, whereas sleep is often a restorative, as in the 
case of your child. If a child has taken a narcotic poison, 
such as a preparation of opium for a typical instance, the 
tendency to sleep much should be combated until the effects 
of the drug are past. In such a case as you are describing, 
however, the condition is one of very mild concussion of the 
brain. Vomiting generally announces the beginning of re- 
action. The notion that children who have had a fall and 
have bumped the head severely should not be allowed to sleep 
is very common in popular medicine, but we do not remem- 
ber to have met it in medical circles. It probably arose 
from a confusion of the stupor of compression of the brain, 
or of the symptoms of the meningitis which sometimes fol- 
lows severe injuries to the head, with the restorative sleep. 



218 THE CENTURY BOOK FOR MOTHERS 

FAINTING 
What is to be done if a child suddenly faints? 

The child will probably fall flat if left alone. If the faint- 
ing is recognized before this, the child should be at once 
laid flat without a pillow. See that the neck is free and 
that no clothing binds the waist or chest in a way to hinder 
respiration. If signs of recovery are not prompt, the limbs 
and lower part of the body may be raised, to cause the blood 
to flow toward the head. Smelling-salts or common am- 
monia may be held to the nostrils. Breathing usually starts 
pretty promptly, after which the patient may generally be 
left undisturbed. The head may be continued in the low 
situation until the patient desires to change its posture. 

CRACKED LIPS AND CHAPPED SKIN 

Please give a remedy for cracked lips and chapped skin. 

We suppose that the effects of cold are meant. The reme- 
dies are, first of all, avoidance of the exposure which caused 
the condition. The skin and lips should be as free from 
moisture as possible, and after the necessary washings the 
parts should be carefully dried. Cracked lips, especially 
cracks at the corners of the mouth, remain so by the con- 
stant use of the parts, talking and laughing often mechan- 
ically injuring the points already inflamed, as well as ex- 
citing a flow of saliva which irritates. Many applications 
are in common use, such as cold-cream, camphor ice, etc., but 
we do not know that they are really better than simple vase- 
line. Their chief value is to protect the cracked or chapped 
surfaces from the air. 



II 

DEFECTS AND BLEMISHES 

FRECKLES 

In the ease of my children freckles attack both sexes with equal 
impartiality, not sparing even my little girl baby of fourteen 
months. If still possible, I should like to save her from the 
fate of her brothers and sisters. Is there a remedy? Of 
course, I know it would be wrong to try to remove freckles by 
anything that might injure the skin; but is there nothing 
harmless that could be used to advantage? Is it advisable to 
avoid exposure to the sun? Will broad-rimmed hats be of any 
use in keeping the fiend off? 

Freckles are annoying, and are often apparently very dis- 
turbing to those who set much store by their complexion. 
These peculiar pigment deposits are usually confined to the 
parts of the person which are exposed to the light— the face 
and hands, namely— and are therefore not easily concealed. 
Although it is true that they sometimes appear upon the 
clothed parts of the body, yet there is very good reason to 
believe that exposure to light is their essential cause. They 
appear in summer, when the hours of light are long and 
outdoor life is most indulged in. Furthermore, freckles are 
peculiar to certain complexions. Brunettes rarely, if ever, 
freckle; they become tanned. Blondes of the florid type— 
those with red or reddish hair— are much more susceptible 
to freckles than others. With the pa.ssing of summer the 
freckles fade or disappear, and in winter they are scarcely 
noticeable ; as adult life is reached they are less evident and 

2r9 



220 THE CENTURY BOOK FOR MOTHERS 

abundant, independently of the care then bestowed upon 
the complexion. 

The causes being thus a peculiarity of complexion and 
exposure to light, it is impossible to do much for them with- 
out doing harm to the general health. Some local applica- 
tions will temporarily make the freckles paler, but the only 
real treatment is prevention by exclusion of light. This, of 
course, will be presently destructive of the health of the 
child. It is possible to lessen the freckling, however, by 
avoiding exposure to the strongest glare of the sun, and the 
shade-hats are of some value in this direction. 



A MARK ON BABY'S FACE 

Our baby is now more than three months old. Two or three 
weeks after her birth a red mark appeared on her nose. We 
thought at first that she had scratched herself pretty vigor- 
ously, but on consulting a physician a few weeks later he pro- 
nounced it a "mother's mark," and advised the use of elec- 
tricity for its. removal; this has been applied three times, 
and the redness has gone from the middle of the mark. 
Would you advise us to continue the use of the electricity, 
or could we do better? We dread to have it used, for it 
frightens the little one very much, and must be painful. Is 
it likely that the mark would disappear of itself after a 
while ? 

I have heard of saliva being used with success to remove marks, 
and also that the juice of the milkweed plant is good. Is it 
probable that either of these would accomplish a cure? 

There are ''mothers' marks" of various kinds and of many 
degrees of severity. Some of the very faintest ones we have 
seen fade partly or wholly without treatment, but as a rule 
they do not. As a mark upon the face of a woman is a mat- 
ter of great concern to her, every endeavor should be made 
to get rid of one, if it be of any importance, before the age 
of self-consciousness. 

The saliva is valueless for the real ' ' mothers ' marks, ' ' and 



DEFECTS AND BLEMISHES 221 

SO, too, is the milkweed-juice. Whatever value the latter 
has is in cases of the most superficial kind. In this case the 
continued use of the electricity seems to be advisable. 



THE REMOVAL OF A BIRTH-MARK 

I wish to consult you about my little five-weeks-old babe, who 
has been unfortunate enough to be birth-marked on the face. 
Both eyelids have reddish veins over them, the left much 
worse than the right. Half of the lid looks red, and there is 
a spot of a darker hue on the right nostril. When the child 
is passive the spots are dim, but when active they become 
brighter. They are not yet blood-red, though I fear they will 
become so. As the complexion clears they become more promi- 
nent. I would like to ask : 

If there is any probability of their dying out without treat- 
ment? 

If electrical treatment is used will it endanger the sight? What 
kind of electricity is needed — galvanism? or would a faradic 
battery do? 

At what age would it be best to commence? 

There is little probability of their spontaneous disappear- 
ance. 

Not if properly applied. The form of electricity used 
in such cases is what is called electrolysis, a needle con- 
nected with the battery being thrust into the part to be de- 
stroyed. It may leave a sear. Neither galvanism nor fara- 
dism as ordinarily applied is of value. 

As soon as the proper surgical attention can be secured. 



WARTS 

Will you tell what one may do to remove warts? My boy, five 
years old, has nine on one hand. I overheard his brother tell- 
ing him he did not love him so well since he had those dread- 
ful things on his hand. What does cause them, and what will 
prevent their coming? 



222 THE CENTURY BOOK FOR MOTHERS 

Warts consist chiefly of an overgrowth of the papillae of the 
skin. The exciting causes of this overgrowth are various, 
and often no cause is recognized. They are more likely to 
occur in childhood, probably because all the phenomena of 
growth are then more active than at other times. They seem 
to be most common where the skin is most exposed to all 
kinds of irritation, as upon the hands. Sometimes they ap- 
pear to be communicated from one person to another, and 
some persons show a great susceptibility to them. 

Warts usually appear suddenly, and often as suddenly 
disappear. Doubtless upon this peculiarity depends the ap- 
parent success of the charms and incantations so commonly 
employed for their removal. It is possible that in some in- 
stances, where the charm involved the rubbing upon the 
warts of the juice of certain leaves, the latter may have 
really had a medicinal influence. 

The most prompt and efficient method of disposing of 
warts is to thoroughly scrape them out. This leaves a little 
''punched-out" looking hole in the skin, which heals quickly 
if kept clean. If any bleeding occurs it can be stopped by 
hot water. This extirpation, if thorough, generally prevents 
a return. 

If this seems too radical a performance for domestic medi- 
cine, the glacial acetic acid or a saturated solution of salicy- 
lic acid may be applied carefully to the wart. The stick 
of a match or a piece of cigar-lighter is a convenient imple- 
ment for making the application. The liquid should be 
applied freely to the wart, but not allowed to flow around. 
The surrounding skin may be protected by vaseline or bicar- 
bonate of soda before the application. After a day or two 
rub off the dead part and make a new application, and repeat 
until the Avart is gone. 



THE BEGINNING AND TREATMENT OF STAMMERING 

My little boy of five has, since his recovery from a severe case of 
scarlet fever, shown signs of stammering. He is sometimes 



DEFECTS AND BLEMISHES 223 

unable to express himself at all, especially when beginning a 
sentence, he repeats certain words, although he may afterward 
speak quite well for hours. How does one know whether this 
is a real case of stuttering? Is it necessary to begin treating 
him? If so, what is the nature of the treatment? 

It is not unusual to meet with cases of stammering at this 
age. The beginnings may often be slight, and scarcely no- 
ticeable either to the child or to the parents. It is always 
necessary to take strenuous measures to prevent a further de- 
velopment of the evil. Usually, the child will not outgrow the 
trouble. On the contrary, it is likely to grow with the child 's 
growth, and what originally may have been but carelessness 
is apt to become a permanent defect. The treatment of so 
young a child calls for gentleness and calmness, for nothing 
is so likely to promote stammering as fear and excitement on 
the part of the child. When a mother perceives that her 
child has the habit of repeating syllables or letters, or of 
incorrectly pronouncing w^ords or syllables, she must not let 
this pass by unnoticed, but she, must quietly and distinctly, 
and without startling the child by too sudden interruption, 
utter the wrongly pronounced word or syllable, and cause 
the little one to repeat it in like manner. If the mother has 
failed to understand the child, let her cause it slowly to 
repeat its words— always, however, without startling it by 
too sudden or violent commands— and let her make it a rule 
never to comply with the wish of a child which it has not 
clearly and distinctly uttered. So young a child cannot, 
of course, be systematically treated, but he can be made to 
speak slowly. The most important thing is to accustom him 
to take breath before he begins to speak. A good plan is 
to tell the child short, simple stories, pausing in the re- 
cital, and letting him repeat part after part slowly and dis- 
tinctly. Gymnastic exercises are, a little later on, of great 
value. If the trouble is persistent, systematic treatment on 
the part of trained and conscientious instructors will be 
called for. 



224 THE CENTURY BOOK FOR MOTHERS 



LISPING 

I am somewhat troubled by the persistence with which my boy 
of six lisps. He pronounces the letter s invariably as th, and 
my efforts to correct him are fruitless. Is he too young for 
systematic exercise in speaking, and what course would you 
recommend ? 

By lisping we understand the false pronunciation of certain 
lingual sounds, particularly z (in zone), s (in sin), and c (in 
cider). This defective pronunciation is in most cases the 
result of habit, often, however, of affectation, and is then 
just as ridiculous as the pronunciation of r by those persons 
who incorrectly produce it by vibration of the uvula; or it 
arises from an abnormal formation of the tongue (too long 
or too short, too broad or too thick) . In the former case it is 
merely necessary for the person to resume a natural manner 
of speech; in the latter the person must, by exercises of the 
tongue and practice of the lingual sounds, be brought to ap- 
proach a correct pronunciation. 

Th is a frequently occurring sound in the English lan- 
guage; when, however, it is applied where it does not be- 
long it is wrong, and is called lisping. But not the false 
placing of the tip of the tongue alone is the cause of lisping ; 
it is also due to too weak a pressure of the tip of the tongue 
on the palate or teeth, and, indeed, a careless holding of the 
tip of the tongue altogether. The same holds good of all 
lingual letters. Those afflicted with this defect must, there- 
fore, place the tip of the tongue exactly on the place just 
described, and this with decision. Those who are troubled 
with the defect of lisping must draw in the tongue, and the 
tip, which is bent back, should be somewhat raised. It is 
better, in exercising, to raise the tip of the tongue too much 
at the outset than too little; the stiffness thereby occasioned 
will disappear with the continuance of exercise. As an exer- 
cise let the mother take the word zone and pronounce it to the 
child in the following manner: First, pronounce the z alone 



DEFECTS AND BLEMISHES 225 

with a sounding expiration ; keep up this buzzing tone for a 
time and then add on the one. Let the child exercise in this 
wdij all the Avords beginning with z. Having become accus- 
tomed to pronouncing the z without thrusting the tongue 
forw^ard and out, he will learn to pronounce all the dental 
letters correctly. 

We do not think the child too young to begin this sys- 
tematic exercise, due care being observed not to fatigue or 
irritate him. 



WANT OF SYMMETRY IN THE FORMATION OF THE HEAD 

My little daughter, nearly eight weeks old, was born easily, after 
what the competent doctor called a quick, normal labor. Nei- 
ther he nor the nurse noticed anything out of the way. But 
since I have had entire charge, I notice that the right side of 
the forehead is slightly more prominent than the left, and 
bulges more in the region of the temple than is the case on 
the left side. The back bulges also on the left. 

Can you not help me to know whether the condition is serious, 
although she gives no sign of being unlike any healthy baby? 

The points to be determined are : Is the distortion more than 
the want of symmetry which is within normal limits, and is 
it increasing or diminishing? You would have saved time 
by asking the physician who attended you in labor if he 
noticed any change. The commonest cause of distortion of 
the head is rickets, and we have seen the oblique form de- 
pending, as we believed, upon this peculiarity, but it is not 
often developed so early. Only a physician who has seen 
the child can give an opinion worth having. 

UMBILICAL GROWTH 

I have a little nephew fifteen months old who has a navel rup- 
ture admitted to have been caused at the time of his birth. A 
small portion of what appears like proud flesh protrudes 
slightly, and occasionally bleeds a little. It constantly exudes 
15 



] 226 THE CENTURY BOOK FOR MOTHERS 

i| 

a watery matter, and must be kept covered with soft linen, 

which becomes thoroughly stained each day. The child seems 
to suffer no inconvenience from the rupture, running and 
I jumping with unusual strength for his age. We are not posi- 

tive that there is tenderness under pressure. He is, however, 
troublesome to dress and care for, and there is also a fear that 
the evil may increase, or that some time a hemorrhage may 
ensue. A local physician has ordered applications of lunar 
caustic. Burnt alum and sugar, and other astringent reme- 
dies, have also been applied, with no effect. What is your 
advice as to treatment? 

The ailment is probably not a rupture, but the description 
corresponds to a kind of fungous growth sometimes observed 
at the navel. If astringents fail, as they seem to have done 
# in this case, the application of the actual cautery (hot iron), 

which is not very painful, although appalling to the imagi- 
nation, generally effects a cure. The treatment should be 
carried out by a competent surgeon, who could give an anes- 
thetic if desirable. 



ROUND SHOULDERS 

My little girl, four years of age, is forty inche's tall and weighs 
thirty-three pounds — a gain of three and a half inches and 
four pounds for the last year. She has always been tall and 
slender, and from the time she began to walk we noticed a 
tendency to round shoulders — a tendency which has slowly de- 
veloped until it is now quite marked. Her father's family, 
with the exception of her father himself and one brother, are 
all very markedly round-shouldered, one case of it in the fam- 
ily amounting to deformity. I have tried long arid patiently, 
speaking to the child and reminding her to hold herself 
straight, but she never remembers more than two seconds at a 
time, and my efforts result in flat failure. I wish to know if 
I should put braces on her this fall, and, if not, should I do so 
at a later time? 

She has always been delicate until the last six or eight months. 
Though not what one could call a very robust child, she seems 



DEFECTS AND BLEMISHES 227 

perfectly well, has a fair appetite for plain, wholesome food, 
and an excellent digestion, is regular in her habits, and sleeps 
soundly and well from ten to eleven and one half hours out 
of the twenty-four. 

First, make sure that near-sight has nothing to do with the 
tendency to stoop, although in so young a child it is not 
so likely to be the cause as in one who has begun to use 
books. Speaking to a child rarely, if ever, does any good in 
this complaint. The stoop is not the result of desire or of 
indolence ; it is usually due to some feebleness of the muscles 
of the back, which may indeed be hereditary, as you seem to 
suppose it to be in this case. The cure is general strengthen- 
ing of the child and gymnastic exercise of the muscles of the 
back and shoulders, which she can get at a calisthenic class. 
If there is any spinal trouble, a support suitable to the par- 
ticular case should be prepared or selected by the surgeon 
who has charge of the case. The use of braces depends upon 
the degree of stoop in the shoulders ; if it is great, or if the 
exercises do not diminish it, the braces are worth trying. 
For directions as to the kind needed, you should consult one 
of the best surgeons in your city. 

FEAR OF BOW-LEGS 

Our baby is a bouncing big one, weighing about twenty-eight 
pounds at a year old. The subject of bow-legs is a serious 
one with us, and consequently we do not allow him to follow 
his inclination to walk. Some say that lime-water will pre- 
vent it, and the ounce of prevention is what we want. What 
do you advise? 

You do not say why bow-legs are anticipated by you. The 
commonest cause of bow-legs is rickets— a disease which is 
characterized, in its full expression, by deformities of the 
bone, due to deficiency of phosphate of lime in the bones, as 
well as overgrowth of their organic parts. The lime-water 
has been used very much as a remedy for rickets, and so in- 



228 THE CENTURY BOOK FOR MOTHERS 

directly to prevent bow-legs. It is not a preventive of bow- 
legs, except when rickets exists. But rickets being a disease 
of nutrition, it is best met and prevented by careful watch- 
ing in this direction, and if any evidences of the early stages 
of the malady exist they should be attended to promptly 
and the disease arrested. A child should be allowed, as a 
rule, to follow its own impulse about getting upon its feet. 
It should not be placed on its feet except, perhaps, when 
struggling to get there of itself. But when a child is able 
to get up alone it is very difficult to hinder it, and there is 
rarely any reason for doing so. 

REMEDIES FOR BOW-LEGS 

How can bow-legs of babies be straightened? 

Bow-legs of a mild degree of severity in infants or very 
young children sometimes straighten in the process of growth. 
Unfortunately, only an experienced physician can predict, 
with any certainty, which these are. We should mention 
that in real babies, as distinct from running children, a curve 
of the leg which is not abnormal is often taken by over- 
anxious parents for bow-legs. When bow-legs really exist to 
any degree, the cure is effected by braces, but in babies who 
are young the limbs can be straightened sometimes by fre- 
quent handling by the mother, her hands pressing the limb 
toward the desired shape. Even if braces are necessary, at 
the same time or later, the manipulation is helpful. 

A CONFIRMED HABIT OF STUMBLING 

Is there any remedy but "moral suasion" for a confirmed habit 
of stumbling on the part of an active boy between five and six 
years old? There is no evidence of weakness in his legs or 
ankles, yet it is a very usual thing for him to fall at the 
slightest obstacle, like a projecting paving-stone or any other 
unevenness in the street, or even in the house, like a door-sill. 
Severe bruises and bumps appear to convey no lesson, and as 



DEFECTS AND BLEMISHES 229 

it seems to be only a habit of extreme carelessness we appeal 
to you to suggest the best punishment. The matter was ren- 
dered very serious to-day by a fall, while running, in which 
our boy struck his forehead on a sharp stone, making two or 
three mutilations which will probably leave permanent scars, 
to say nothing of the present pain, which will keep him housed 
for nursing for some days. We tremble to think of what the 
consequence would have been had the stone struck his eye 
instead. 

Differences in natural agility are very great. Further, 
clumsiness is often increased by certain illnesses. For in- 
stance, some diseases, like scarlatina and diphtheria, which 
have often paralytic sequels, sometimes are followed by a 
certain clumsiness of gait, which depends upon no recog- 
nizable paralytic condition. We can recall children whose 
gait after such diseases was strong and enduring, but whose 
feet fell like hammers. Again, some ailments cause a dimi- 
nution of that harmony of movement called coordination ; this 
is one of the results of phimosis. The harmfulness of phi- 
mosis has been much exaggerated ; nevertheless, in every case 
of excessive clumsiness in a boy this possible cause should 
be inquired into. In any case, we should not think of pun- 
ishment to cure stumbling. If judicious coaxing and '^ slow- 
ing down" will not break the habit, punishment will not, 
but will rather render the child more self-conscious, and 
therefore more clumsy. 

It may be added that near-sight or some other defect of 
vision is often the cause of stumbling. 

A TONGUE-TIED BABY 

What shall be done for a baby that is tongue-tied? Shall the 
string be cut? 

"Tongue-tied" means that the natural bridle under the 
tongue is so much shorter than usual as to inconvenience 
the child in som.e way. It is rarely as much of a hindrance 



230 THE CENTURY BOOK FOR MOTHERS 

to speech as is supposed, because if the child's tongue is free 
enough for it to suck well, it is free enough for speaking. 
Occasionally, though rarely, a child is born with so short a 
tongue bridle as to prevent nursing, and in such cases cut- 
ting of the bridle is demanded. In other cases it is not 
really called for, although sometimes done in obedience to a 
popular belief. The cutting is a trivial matter, if done by a 
competent person. 



CLEFT PALATE AND HARELIP 

Can the trouble called "cleft palate" or "harelip" be easily 
cured? Are its symptoms unmistakable? 



Cleft palate and harelip are not the same trouble, but allied 
ones. Both are due to a defect of development, the parts 
from which the face is made up not being completely fused. 
Harelip is more frequent than cleft palate. It may occur in 
one or both sides, the splits in the lip being below the nos- 
trils, never in the middle. The cleft palate may involve the 
soft palate, or the hard palate as well. Harelip can gener- 
ally be cured by an operation of no great difficulty, although 
involving some nicety to obtain the most satisfactory results. 
The operation for cleft palate is more difficult, but usually 
quite successful. It can be cured only by operation. 

There are no symptoms in the ordinary sense of that word. 
There is a very evident physical defect. If the defect be so 
great as to interfere with nursing, nutrition is difficult, and 
in one sense the symptoms of the resulting inanition might 
be attributed to the causative defect. 



"WHOPPER-JAW" 

My baby is now over ten months old. She has cut the upper 
and lower central incisors, and is now getting the lateral in- 
cisors. The under teeth shut over the upper ones. Is there 
any danger of her being "whopper- jawed" when she has all 



DEFECTS AND BLEMISHES 231 

her teeth? If so, can anything be done to prevent it? Her 
mouth when closed appears perfect, though the teeth are as I 
have described. 

The projection of the under jaw, rather than of the teeth 
themselves, usually causes the condition of "whopper- jaw," 
and it is doubtful whether it can be artificially modified. If 
the condition continues and appears dependent upon the 
teeth, your dentist can tell you if their position can be rec- 
tified. 

DEAF-MUTISM 

What would you think of a child nearly three years old who did 
not say a single word? I do not mean one who has a lan- 
guage of his own, unintelligible to others, the simple fact 
being that he does not attempt to utter a word, and it is very 
hard to see that he comprehends when spoken to. I have in 
mind a little fellow who is causing us much anxiety on ac- 
count of his backwardness about talking, or rather of his not 
speaking. What would you advise? 

Such a child should be first of all examined for deaf -mutism, 
and, if it hears well, some one familiar with such matters 
should inquire into its intelligence. In order to ascertain 
whether the child hears, the aurist relies upon the tuning- 
fork, whistle, and bell, or instruments producing noises of a 
similar character. In applying any of these tests it is neces- 
sary to be on one's guard, and exclude the possibility of 
the child having its attention called to the various testing- 
objects by senses other than that of hearing. For instance, 
the mother may test with a whistle ; the child turns at once, 
and she reasons that it has heard the sound. This, how- 
ever, may not have been the case ; the blast of air leaving the 
whistle may have impinged upon the child's face, and this 
may have caused it to turn around. In like manner, a child 
may turn because it feels the vibrations transmitted by the 
floor, following the violent closure of a door ; yet this action 



232 THE CENTURY BOOK FOR MOTHERS 

on the part of the child may be wrongfully attributed to its 
having heard the noise. 

An important peculiarity of deaf-mutes, though not in 
itself an absolute proof, is their manner of expressing their 
desires through gestures, and their impatience and anger 
when not understood at once. One of the most important 
signs, of course, is the fact that the child does not begin to 
talk when it should. No mother should accept the verdict 
of deaf-mutism until such an opinion has been given by a 
competent aurist, after he has examined the child's ears. A 
child may, as a result of being born so, or as the consequence 
of disease of the ear after birth, whether this has been no- 
ticed or not, be very hard of hearing, and yet not be abso- 
lutely deaf. If nothing be done for such a child, its deaf- 
ness beconies worse from disuse of the organ of hearing, and 
finally may become absolute, while if proper training and 
treatment had been instituted in such a case, some ameliora- 
tion of the defect might have been achieved. 



Ill 

COLDS AND CATARRH 

FRESH AIR AND COLDS 

I would like to know if a child six months old that has not been 
out of the house for many weeks ought, in your opinion, to be 
taken out during the winter on moderately pleasant days. The 
child is not very large or strong for her age, and is raised on 
the bottle; she discharges from the nose as if she had a cold 
most of the time. 

The facts given are too few to enable us to answer defi- 
nitely, but from the following general remarks you may be 
able to make an application to your baby 's case : In the 
first place, we do not believe in taking out children in all 
kinds of weather regardless of consequences, which is a part 
of the senseless ''hardening" theory. The safe rule is, Ave 
think, this: Children ought to be regularly sent out, except 
when there is rain or when, by reason of great cold and 
very high wind, they cannot be kept comfortable. On such 
days we believe in the value of a promenade, the child 
dressed as for an out-door walk, in a room which has been 
thoroughly opened to the air. In this way it can get some- 
thing of a change without exposure. But there are some 
children who do not seem to do well if allowed to go out of 
doors on any but the "bright and airless" days. This is 
particularly noticeable in the city when the streets are loaded 
with mud and slush, and we think evil effects are more no- 
ticeable in children who are old enough to walk than in 



t 

234 THE CENTURY BOOK FOR MOTHERS 

infants. This may be attributed to the inactivity of the 
children who walk slowly along on the sidewalks or are 
obliged to stand at street corners while a conversation is car- 
ried on by those in charge. The children whose animal 
spirits lead them into continuous romping out of doors suf- 
fer less. Be the cause what it may, some children, as we 
have said, do not well endure their daily walk, and are in 
less frequent need of medical advice when kept in on all but 
very fine days. Going out seems to keep them supplied with 
''colds" and other little ailments. But before the attempt 
to take the child out is given up one should make sure that 
the attendant inconveniences are unavoidable. If there were 
not so frequent an assumption to the contrary, it would be 
unnecessary to say that there is no deleterious element in 
out-door air that is not in in-door air; our in-door supply 
must come from without, and we certainly do not purify it 
in our dwellings. What we do avoid indoors is a. too low 
temperature and the violent force of winds and, to some 
extent, the all-pervading dust. 

If possible, let the child be carried. Your six-months' 
baby probably could be; this gives her the warmth of the 
arms of the person carrying her. But see to it that she is 
well protected everywhere, not only about the head and 
trunk, but about the legs. Many a little child we meet whose 
legs protrude helplessly from its finery. If the child is in 
long clothes, let them be not too fine to be doubled up or 
folded around the legs. They are for warmth, not for deco- 
rative art. If it has reached the age of short clothes, and is 
to be carried, we prefer to knitted leggings, with the shoes 
protruding, a petticoat of short flannel or a blanket, sewed 
up at the bottom like the sleeping-bag of camp-life. This 
keeps the feet warm, while allowing the legs freedom of 
motion. 

A word as to the ''cold." This term is so fixed in our 
speech that it is useless to quarrel with it. It is only neces- 
sary to mention here that the symptoms are not always, and 
perhaps not usually, due to the chilling of the person. And 



I 



COLDS AND CATARRH 235 

when the trouble is persistent, as in the present case, this is 
almost certainly not the cause. There may be a local cause 
in the nose, or the trouble may depend upon the feebleness 
of constitution of which you speak. Perhaps this feebleness 
is to some extent kept up by the child 's lack of fresh air. At 
all events the cause of the discharge ought to be inquired into. 

COMPREHENSIVE QUESTIONS CONCERNING 
COUGHS AND COLDS 

Please give me some simple home remedies for tight cough, loose 
cough, head cold, with running at nose, cold on the lungs, 
hoarse cold — always understanding that if sufficient relief is 
not obtained a physician will be consulted. 

The various ailments you ask remedies for are usually sim- 
ply different stages or manifestations of the same thing— 
namely, a catarrhal inflammation of the mucous membrane 
of the air-passages. A "cold" may go through the whole 
range, or it may be confined to or chiefly manifested in some 
particular parts of the passages. A typical bronchitis, for 
instance, begins with a *'nose cold," or coryza. The irrita- 
tion quickly attacks the larynx, causing a ''hoarse cold," 
laryngitis, which may be attended in some children with the 
symptoms of false croup. It then passes into the windpipe 
(trachea) and the larger bronchi, making a bronchitis. In 
the first congestion, the cough is ''tight," and there is a 
sense of constriction; later, as the mucous membrane begins 
to secrete freely, and the discharge increases, it is said to be 
""loose." To the physician, the whole procession of events 
is one malady, and he would probably attack it as such, if 
he had the opportunity, in the beginning. Usually, how- 
ever, the catarrh is well established before he is called (if at 
all), and he must then simply give remedies to ease this or 
that symptom, and to try to abbreviate the course of the 
"cold," which, let alone, would usually, from beginning to 
end, cover about a fortnight. It should be noted (although 
we cannot here discuss it) that "colds" are not, by any 



236 THE CENTURY BOOK FOR MOTHERS 

means, the same thing in all cases. The "prevailing colds" 
are probably clue to some special poison, affecting many peo- 
ple at once in a way similar to that in which the now very 
familiar disease "influenza" or "la grippe" attacks a com- 
munity. There are, however, some real "colds," due to 
effects of change of temperature. Thus, some persons can- 
not sit in a draft without experiencing subsequent pain and 
stiffness in the exposed parts. Persons whose naso-pharyn- 
geal mucous membrane is not in sound condition are always 
catching cold— i. e., having slight exacerbations of their ordi- 
nary catarrhal condition, which they may be so accustomed 
to as not to recognize it in its true light. 

For the relief of symptoms, then, changing the order of 
your questions, the head cold may be treated with local ap- 
plications, such as steam of hot water, when the sneezing 
and other signs of irritation first appear, and sprays of some 
safe antiseptic, such as "listerine, " diluted with five to ten 
times its bulk of water, after the discharge is established. 
Internally, a great many remedies have had repute. One 
much used is the so-called "rhinitis pill" (rhinitis meaning 
inflammation of the nose) , which contains quinine, camphor, 
and belladonna in small amounts. 

The hoarse cold is chiefly important from the possibility 
of an attack of croup. So far as domestic treatment is con- 
cerned, the remedies before mentioned are about as good as 
any, noting that steam is especially useful, as being more 
easily applicable. Sometimes comfort is obtained by the 
use of soothing mixtures, known to physicians as "demul- 
cents," such as flaxseed tea, or elm-bark tea, and the like, 
and, what is particularly acceptable to the childish palate, 
the mixture of butter and molasses cooked into a viscid mass, 
popularly called "stewed Quaker." 

The "cold on the lungs" probably is intended to mean 
bronchitis, as described above. The fault of domestic diag- 
nosis is that it has no means of distinguishing from ordinary 
bronchitis pneumonia or pleurisy, which have cough,— the 
latter often a peculiarly "tight" and painful one. Leaving 



COLDS AND CATARRH 237 

this aside, we may say that the domestic remedies suitable to 
the "tight" stage are simply those which allay irritation 
and favor the flow of the bronchial secretion. For the for- 
mer, opium in small doses is very useful, hence the repute 
of paregoric and Dover's powder. In the former the opium 
is combined with camphor, in the latter Avith ipecac. Of 
medicines promoting bronchial secretions, or expectorants, 
ipecac and squills are familiar examples, the former being 
preferable for nursery use. When a cough is loose— i. e., 
when the secretion is already sufficiently free— it is doubtful 
if any drugs proper for domestic administration are desir- 
able, beyond the simplest soothing mixtures, the "demul- 
cents" spoken of before. Tonics and remedies conducive to 
hastening convalescence are useful, but not within the proper 
range of household medicine. 

TREATMENT OF A "HARD COLD" 

What is the proper management of a hard cold in the case of an 
eighteen-months-old child? It has made him exceedingly ner- 
vous, and his naps are much disturbed by coughing. The cold 
is in his head, but I keep throat and chest well oiled, and 
have given no medicine. 

The medicinal treatment of a "hard cold" we cannot give 
you, because the phrase has no definite meaning, and if there 
be any need of medicinal treatment at all, it is not domestic 
treatment alone. In jovlv child's case, in this particular in- 
stance, the "hard cold" seems to mean a bronchitis, with the 
usual acute nasal catarrh, sufficiently severe to disturb his 
sleep by obstruction to his breathing. The cough, probably 
bronchial, increases the disturbance. The nursing of such 
a case consists in keeping the child warm enough, but not 
burdened with jclothing, in moderately warm but not stuffy 
air, in giving light diet, and keeping the bowels free. The 
oiling of the chest is harmless ; we cannot say that it is defi- 
nitely curative, unless the oil contains some slightly irritating 
substance, such as camphor or a little turpentine. 



238 THE CENTURY BOOK FOR MOTHERS 

CAUSES AND TREATMENT OF CATARRH 

I have four little girls who are, respectively, seven, five, three, and 
one year old. With each approach of winter and more or less 
all through they are troubled with catarrh, earache, and croup- 
ous cough. We have a comfortable new home, deep water, nat- 
ural gas in the kitchen, and wood fire in the nursery. We live 
in the country, within three minutes' walk of the church or 
school. This catarrhal tendency is inherited from the mother. 

Which would you advise — to try a local remedy? If so, what? 
Or to move to a warmer climate? If so, where? 

It would appear that your surroundings are satisfactory 
and not responsible for the catarrhal tendency. Such a ten- 
dency undoubtedly is caused by or aggravated by heredity, 
but very much also depends upon exciting causes. Let us 
take up the conditions, as you put them: Catarrh— that is, 
nasal or throat catarrh; earache, doubtless dependent upon 
extension of the catarrhal inflammation from the throat 
through the Eustachian tube to the middle ear; croupy 
cough, dependent upon a catarrhal laryngitis, also usually an 
extension from the pharynx. So the Avhole comes back to 
the nose or throat catarrh. Now, the commonest cause of this 
trouble in its chronic or recurring form is an enlargement of 
the glandular body in the posterior nasal cavity, known as the 
^' third tonsil" or as an ''adenoid." Catarrhal conditions ex- 
ist with any such enlargement, but if the latter be present, 
success in treatment of the catarrh will hardly be gained 
without the removal of this mass. Such removal is the first 
and most efficient local remedy. We cannot tell you how to 
And out the exact causes of the trouble for yourself. A physi- 
cian familiar with the proper state of the nasal cavities can 
tell by the use of his finger whether any such obstruction 
exists. Its removal should be effected by him if he be famil- 
iar with the operation. 

If no enlargement exists, or after it has been removed, a 
good deal can be done by local applications. Any good 
cleansing spray will do good, but we do not lay stress upon 



COLDS AND CATARRH 239 

that until the prime question of the growth in the nasal 
cavities is settled. As you have evidently considered the 
need of removal of your home, you doubtless would be still 
more ready to make a journey for treatment— if you cannot 
find what you need at home— to a city where good medical 
advice can be obtained. 

One or two things else may be mentioned. Where the 
catarrh depends upon inherited weakness, as you think it 
does in the case of your children, usually a good deal is 
gained by the persistent use of cod-liver oil through the cool 
months. Again, a good many of the existing causes of ca- 
tarrhal attacks may be prevented by strict attention to dress 
and general hygiene. 

THE COMMUNICABILITY OF CATARRH 

Will you kindly inform me if there is any danger in a person 
caring for an infant who has catarrh of the head? 

We suppose you mean, Is there danger to the attendant ? and 
that by catarrh you mean an ordinary chronic catarrhal dis- 
charge from the nose. We particularize because the popular 
use of the word catarrh covers a variety of disorders, from an 
ordinary fresh "cold in the head" to special diseases of the 
nasal cavities. But taking the question to mean what we have 
above supposed, Ave should say that there was no danger to 
the attendant. If you mean. Is there danger to the infant 
if the attendant has nasal catarrh? we should say that it 
would depend upon the kind of "catarrh." These acute 
colds in the head seem to be communicable. Ordinary 
chronic nasal catarrhs seem not to be, while there are occa- 
sional cases of quite another kind which should be guarded 
against. 

CARE OF A SENSITIVE THROAT 

My baby of two years has, I fear, a delicacy of the throat. Her 
voice will become quite hoarse after a few minutes' exposure 
to damp air, and without any other sign of a "cold." She has 



240 THE CENTURY BOOK FOR MOTHERS 

now been very hoarse for a week. Occasionally, in taking her 
up in the morning, I can detect a slight odor of mucus. 

I have given no medicines. She rarely has a "cold." So far I 
have only been careful in protecting her feet from damp 
ground, and in keeping on her a light-weight woolen shirt. Is 
there anything further that I can do, and do you think she 
will outgrow the tendency? 

I ought to mention that last winter she had bronchial pneumonia, 
her only illness, but as she apparently recovered without any 
weakness, and this hoarseness dates back to last summer, I 
have not considered the illness responsible for her present con- 
dition. 

It is difficult to really treat the throat of a child of two years, 
but something may be done. Apparently the child has a 
nasal catarrh, the mucous membrane being easily affected 
by damp air. For the present we think it wise to try to 
teach her to let you cleanse the nose and throat with a spray. 
The reasons for this are that cleansing the mucous membrane 
tends to improve its condition, and, above all, prevents 
various organisms from making their home there and then 
setting up the more serious throat diseases. 



TAKING COLD EASILY 

My baby, nearly two years old, takes cold very easily, I never 
know how. She perspires on slight cause. When asleep, with 
only a little covering, her head will very soon be wet. Her 
feet, too, perspire easily; in fact, her stockings are almost al- 
ways damp and her feet often cold. Of course I know she 
needs some constitutional remedy for this, and I do use some- 
thing when she is not taking other medicine for a cold, but is 
there anything I can do locally? 

The two symptoms mentioned, sweating of the head and 
taking cold easily, are suggestive of that form of malnutri- 
tion known as rachitis, or rickets. If this exists, the remedy 
lies in nutritious and digestible food, cool sponging of the 



COLDS AND CATARRH 241 

skin, and Avhatever else goes to make up sound hygiene. 
Sometimes tonics are needed. But the preventing of the 
colds by proper hygiene is far better than dosing for them. 



COLD IN THE HEAD; APPLICATION OF VASELINE 

My baby is almost nine months old and weighs about twenty 
pounds, exclusive of clothing. She seems strong and active, 
but has had two or three troublesome head colds and is inclined 
to constipation. She has two teeth, which were cut without 
any trouble, is fed entirely from the breast, and usually takes 
six meals during the twenty-four hours. 

Our house is quite "drafty," so that baby is kept a good deal 
in her high chair and carriage. Ought she to exercise on the 
floor? 

Is there anything to do for a cold in the head except to apply 
vaseline about the nose and forehead? 

It is not necessary for her to be on the floor, but she 
should have opportunity to use her limbs. The high chair 
is confining; the carriage is better. Why not let her play 
upon a bed with sides to keep her from falling off, which 
would be still better? 

Various solutions can be used in the form of spray from 
an atomizer. But you would better not select the solu- 
tion without medical advice. The vaseline should be used 
in the nose, rather than around it. Warm it, and if you 
have no suitable atomizer, put it into the nostril with a soft 
camel's-hair brush or by dropping in a little. 



"STARVING A COLD" 

You would oblige me if you would state whether a young child 
having a cold should be kept on a very plain diet while the 
cold lasts. Do you believe in what is commonly called "starv- 
ing a cold"? My little five-year-old niece has been coughing 
for some time and looks pale, yet she is generally contented 
and happy. Would it be best to give her gruel, milk and 
16 



242 THE CENTURY BOOK FOR MOTHERS 

water, etc., and but very little meat, while the cold lasts? 
Should she be kept very quiet and sleep as much as possible? 

The proverb from which our correspondent quotes is quite 
as often reversed; indeed, we first learned it, ^^ stuff a cold 
and starve a fever." The question, as specifically put, is 
also too vague to be answered categorically, since so many 
ailments go under the name of ''a cold." But we may an- 
swer in a general way thus: This child has been coughing 
for some time, and has probably a catarrh of the throat or 
windpipe. She is somewhat depressed by it, as shown by her 
paleness. As far, then, as the diet needs supervision, it 
should be for the purpose of securing good nutrition with 
easy digestion. The milk, if good, ans^vers both indications. 
The gruels, if milk-gruels, are also useful. If she can CEisily 
digest a little meat in the early part of the day, it may be 
allowed, but it will not be needed if plenty of milk be taken. 
Good, nutritious broths, not greasy, are also good; so some- 
times are fresh eggs. It will be noticed that while the food 
in question is "light" in the sense of liquid, it is exceed- 
ingly nutritious, and that it gives no indorsement at all of 
any starvation theory. Great confusion exists popularly as 
to what is nutritious diet. Much food that would be very 
nutritious to a robust adult digestion is only wasted and irri- 
tating when put into a stomach that cannot manage it. 



lY 
WHOOPING-COUGH 

THE FIRST SYMPTOMS OF WHOOPING-COUGH 

Can you tell me what are the first symptoms of whooping-cough? 
Do they differ in any way from those of an ordinary cold and 
cough ? 

The first stage of whooping-cough presents symptoms of a 
catarrh of the upper air-passages and bronchitis which has 
nothing to distinguish it from an ordinary inflammation of 
these parts. There is sneezing, with some suffusion of the 
eyes and running at the nose, but less than is seen with mea- 
sles. The cough is accompanied by very little, if any, expec- 
toration. After these symptoms have lasted from one to two 
weeks, it is noticed that the cough becomes severer and as- 
sumes a spasmodic character. The cough is worse at night, 
and whenever the child becomes excited from any cause. It 
takes place entirely in paroxysms, between which the child 
is perfectly well. A paroxysm begins with a tickling sensa- 
tion or a feeling of constriction in the throat. It consists of 
a series of expirations which expel much of the air in the 
lungs, followed by a quick inspiration that produces the 
sound known as the *' whoop." When children begin to 
vomit in connection with fits of coughing, we can be suspi- 
cious of whooping-cough, even if the ** whoop" has not 
occurred. 

243 



244 THE CENTURY BOOK FOR MOTHERS 

SUPPOSED IGNORANCE OF PHYSICIANS CONCERNING 
WHOOPING-COUGH 

Two of my children, one two years old and the other five, have 
had whooping-cough rather mildly for the last two months, 
but I think they are on the mend. What would improve their 
case? 

I regret to say that the medical faculty do not seem to know 
much more about it than was known fifty years ago. 

Whooping-cough is a disease, if not of fixed, at least of pro- 
longed, course. The "medical faculty" know a great deal 
more about it than they did fifty years ago. But medical 
science usually does not, and we suspect will not, abbreviate 
the course of diseases of an infectious nature after they are 
well begun. AVhat has been accomplished in many of them 
is this: To recognize their natural career, the accidents 
and dangerous complications attending them; to point out 
the best means of avoiding or treating the latter, and 
of mitigating symptoms and hastening convalescence. Most 
of all, science has pointed out means of avoiding con- 
tagion. 

Now, as to the particular cases in hand. The children are 
mending, and in all probability will soon be cured. But 
we can offer you a few hints which may be serviceable. 
First of all, winter is coming, and in your climate will come 
soon. It is very desirable not to enter the cold season with 
the bronchitis of whooping-cough still lingering, because of 
its tendency to exacerbations and to chest complications. 
See to it, therefore, that your little ones are properly clothed 
from throat to foot, evenly, warmly, but not burdensomely. 
Try to keep your indoor temperature moderate (not above 
70 degrees, preferably nearer 65), and as uniform as pos- 
sible. Kegulate their outdoor clothing each day by the ther- 
mometer, which will probably vary a good deal in the 
coming months. Try to teach the habit of breathing through 
the nostrils^ as mouth-breathing is likely to excite cough in 



WHOOPING-COUGH 245 

children recovering from whooping-cough. Many little de- 
tails will occur to you for which we have not space. 

Secondly, attend to the diet and to the digestion, as any 
derangement of the stomach aggravates the tendency to 
cough and to recurrences. If there is any marked digestive 
trouble, medicinal remedies will be needed— tonics, sto- 
machics, etc., according to the nature of the derangement. 

Beyond these points we need not specify, except that abun- 
dant and pure air in or out of doors is always a tonic. By 
pure air we do not mean harsh air, nor gales of wind, which 
may bring anything but purity with them. 



CONTAGION OF WHOOPING-COUGH 

Can whooping-cough be carried from one child to another with- 
out the two children being together? At what time in the 
duration of whooping-cough does one child give it to another? 

The poison, or contagium, of whooping-cough is generally 
supposed to be very volatile— i. e., easily spread about in the 
air. It therefore is very easily contagious if a sufferer be 
brought near others who are not protected, while for the same 
reason the poison is thought not to cling to apparel, and 
hence to be not portable, at least for any considerable dis- 
tance. The disease is communicable from a person as long 
as the cough continues. 



SEVERITY OF WHOOPING-COUGH IN 
RELATION TO AGE 

Does whooping-cough generally "go harder" with infants, say 
seven or eight months old, than with children somewhat older, 
other things being equal? 

We cannot answer the question in the precise form in which 
it is put— that is, to say whether the severity of the disease 
is greater at seven or eight months than at a somewhat later 



246 



THE CENTURY BOOK FOR MOTHERS 



period, because we do not know how much older children 
you have in mind. This, however, we can say: The mor- 
tality from whooping-cough— doubtless chiefly from pulmon- 
ary complications — is much greater in young children than 
in those of what is called "the school age." In fact, the 
mortality is chiefly under three, indeed even under two years 
of age. The actual per-centum loss, however, in children of 
ordinary strength and well cared for is not very great, al- 
though among the poor and neglected classes the disease and 
its sequels account for an enormous total mortality. In the 
mild season the danger of pulmonary complications is less, 
and hence the danger from the disease is less. 



DIFFICULTIES OF WALKING AND 
DISORDERS OF THE LIMBS 

THE POSSIBLE DANGERS FROM EARLY WALKING 

Can it hurt a child to begin to walk too early? My little 
daughter is not quite eleven months old, and shows a very 
decided desire to get on her feet. Should she be discouraged? 
I have been told that she might get weak ankles or some other 
trouble if allowed to walk too soon. 

In a general way, it may be said that if a child were urged 
to walk before the joint tissues were strong enough certain 
deformities might ensue, the injuries usually attributed to 
early walking being bow-legs, knock-knee, and weak ankles. 
The phrase ''weak ankles" generally means an ankle that is 
not firm in its support of the body by reason of relaxations of 
the ligaments, particularly those on the sides of the joint. 
Occasionally we see a ''weak ankle" which is such by reason 
of a general flabbiness of tissues, the muscles of the leg which 
move the foot sharing in this weakness. There is a kind of 
knock-knee also due to relaxed ligaments, but it is not very 
common in children, being usually acquired later, as a result 
of injury, or of some peculiar occupation. Still, it is well to 
be on one's guard in the case of a child that appears to be 
prematurely desirous of getting on her feet. She certainly 
ought not to be encouraged in any way. 

247 



248 THE CENTURY BOOK FOR MOTHERS 



POSSIBLY OVERBURDENED LIMBS 

My little boy, twenty months old, seems to be a little weak 
around the ankles, and when he is walking the lower part of 
the limb appears as if it were bowed. lie is very healthy 
and well in every way, and weighs something over thirty 
pounds. The legs are not bowed, but can be pressed together 
very easily; for some little while back I have been in the 
habit of pressing them together when dressing him for bed 
in the evening, and it appears to have done some good. He 
has not been sick one day since being born. Will you kindly 
give me some advice as to what is the best thing to do under 
the circumstances ? 

It is not clear that anything is really the matter. The child is 
twenty months old, and his weight, if it be nude weight, is 
that of a three-year-old child. The limbs probably are a 
little overburdened at present. The best thing, we believe, 
will be to gently manipulate them to stimulate the growth 
of the muscles, and to try to discourage unnecessary standing. 



TURNING-IN OF THE TOES 

What can be done for a twenty-months' baby who shows a de- 
cided tendency to walking with toes turned in? She has not 
inherited the tendency, and I have tried to be careful to have 
her shoes large enough, though she grows so rapidly that her 
toe generally finds the end before the new ones are bought. 

Examine carefully (best when baby is naked) to see if the 
turning-in is at the ankle— or, more exactly, at the joint be- 
tween the instep and ankle — or whether the whole limb rolls 
in from the hip. If the trouble is in the foot, perhaps some 
support is necessary, but that will depend upon the degree 
of the twist. If the trouble is at the hip it may be only 
the natural tendency to walk with the toes forward rather 
than outw^ard. Rubbing and kneading of the flesh about the 
hip that makes the prominences of the buttocks may develop 



DISORDERS OF THE LIMBS 249 

the muscles there and thus give greater power to turn out 
the toes. Such cases have a multitude of varieties and de- 
grees, and the need of artificial support cannot be definitely 
determined from a short description. 

In walking the natural tendency to turn the feet in is par- 
ticularly marked in children. It is often observed that some 
children turn in the toes of one or both feet very much when 
walking, although no real club-foot or distinct disease exists. 
This peculiarity is often— indeed, usually— cured before 
adult life by the child itself when old enough to give its 
attention to it. If it is very marked it probably requires the 
action of some light, properly constructed apparatus to over- 
come it. This can be directed only by some surgeon familiar 
with this kind of cases, and he can best advise you whether 
the condition is really of sufficient importance to need treat- 
ment at all. By yourself you can do little more than to 
call the child's attention to the turning-in of the toes when 
she is old enough to understand you, and so prompt her to 
an effort at cure. 



DISINCLINATION TO PUT THE FOOT DOWN 

Our little girl, eight months old, wants to stand all the time on 
her toes, and it is hard to get her to put her foot flat down. 
Can we do anything to remedy this, or will she outgrow it? 

It is rather early for the child to be making serious attempts 
at walking, and until she does the question cannot really be 
answered. You may find out something in this way : When 
she is sitting or lying, take the limbs (one at a time) in your 
hands; straighten the knee completely, so that the thigh and 
leg are in a straight line; hold the limb thus, and press 
the toes and front of the foot upward, and see if there is 
any difficulty in bringing the sole to a right angle (or rather 
beyond) with the line of the leg. Do this several times to 
each limb, until you feel quite sure what is the condition. 
If you cannot easily bring the foot to or beyond the right 



250 THE CENTURY BOOK FOR MOTHERS 

angle, ask your physician to examine it. This is the best 
advice we can offer, as it may be only a trick of the child, 
or it may be due to some unusual rigidity of the calf mus- 
cles. There are a number of ailments in which this draw- 
ing up of the heel exists. 



WEAK LIMBS 

My baby, thirteen months old, has crept for some time, but does 
not try to stand at all yet or pull himself up, and does not 
seem to care to rest on his feet. As he is quite fleshy, is it 
best to let him partly rest his weight on his feet, and in this 
way teach him to walk? Some of my friends think it would 
be best; but as his ankles and limbs seem weak yet, I am so 
afraid of injuring them. Will you please give your opinion? 

Do not hurry him at all. If he does not walk for six (or 
indeed twelve) months yet, it is better than putting a heavy 
baby on his legs prematurely. A baby that creeps well is 
not without ambition, and will get up as soon as it is safe. 
If his limbs are distinctly weak you may rub them and 
bathe them with salt and water, but do not urge him to walk 
at present. 

THE SIGNIFICANCE OF A LIMP 

If a child of four suddenly begins to limp, without any apparent 
cause, and continues to do so for some time, is it a sign of 
hip trouble? 

Not necessarily. Limps come from many causes associated 
with the lower limbs or the spine, especially its lower part. 
The persistent limps of children nearly all belong to two 
groups— those which are due to loss of muscular power, such 
as follows any kind of paralysis, and those which are due to 
the endeavor, often unconscious, to spare an inflamed or sen- 
sitive joint. To the latter group belongs the limp of hip 
disease in its early stages. If a child with any tender joint 



DISORDERS OF THE LIMBS 251 

or bone of the lower extremity be watched it will be observed 
that that particular joint shares less than it should in the 
motions of the limb or not at all. If it be the hip which 
is at fault, that joint will be noticed to be more or less rigid 
in walking or if the member be moved. Ordinarily the lower 
part of the spine endeavors to move more than is usual to 
make good the loss of mobility at the hip. If a child is no- 
ticed for any reason persistently or frequently to spare a 
joint, it is advisable to seek medical opinion. 

POTT'S DISEASE 

What are the first symptoms of Pott's disease? What is its 
cause and cure? 

Ordinarily the first thing that the family notices is the promi- 
nence of the affected vertebra. But there can usually be 
noticed, sometimes earlier, a rigidity of the spine, an unwill- 
ingness to bend it, and unconscious endeavors to relieve it 
from bearing weight, as by lying down or, in standing, to 
hold on to chairs or furniture or to support the shoulders 
and chest by the hands upon the knees, so that the weight is 
carried upon the arms, knees, and legs, rather than upon 
the spine. Besides, there is often a grunting respiration if 
the chest vertebrae are affected, colicky pains if the lower ones 
are the seat of disease. These are the commonest early symp- 
toms likely to be noticed by a mother or an attendant. 

The disease is a tubercular inflammation of the bone. Its 
cause, therefore, is essentially the infection of the part by 
the tubercular bacillus. Some have thought that slight in- 
juries have proved the exciting cause, and it may be so, but 
it is not clear whether in the cases in which an injury has 
occurred the latter irritates an already existing tubercular 
deposit, or whether the disturbances caused by a slight in- 
jury become subsequently infected. The main factor in any 
case is the tubercle. 

The cure is a very long and tedious one. The main fea- 



252 



THE CENTURY BOOK FOR MOTHERS 



tures of the treatment are two: The employment of all the 
hygienic and medicinal remedies which are effective against 
tubercular infection anywhere, and the support of the spine 
by proper apparatus, to limit irritation and prevent de- 
formity as far as possible. 

KNOCK-KNEE 

What is knock-knee ? How can one clearly recognize that a baby 
who is just beginning to walk has it? 

It is such a change in the bones or the joint structures as 
allows the knees to come unduly close to each other, or even 
to interfere Avith each other, while usually the ankles and 
feet are correspondingly separated more than usual. 

WEAK ANKLES 

What can be done to strengthen weak ankles in a child of three 

years ? 



The weak ankles may be a part of a general flabbiness of 
make-up, either congenital or the result of illness, or they may 
be due to a lax condition of the ligaments of the ankles. In 
either case, but especially in the former, everything (includ- 
ing good hygiene, careful feeding, showering, massage, and 
rubbing of the parts) Avhich tends to strengthen the ankles is 
proper. Besides, in case the weakness is so great as to hinder 
the proper taking of exercise, ankle supports of leather, ar- 
ranged to go inside the shoes and sold in the shops, may be 
used. This is about the limit of domestic resource, but the 
physician has some more at his command. 



VI 

CONSTIPATION 



CONSTIPATION IN BOTH MOTHER AND CHILD; 
LAXATIVE DIET; THE ACTION OF SENNA 

I have always been more or less constipated, and fear that my 
baby, whom I am nursing, has inherited this tendency. Is 
this generally the case ? She is otherwise well in every respect. 

Her sister of two and a half is also troubled by constipation. 
What would be a laxative diet for her? 

It seems to be generally believed that constipation in a 
nursing mother is the cause of the same trouble in the child, 
but it would be difficult to prove or disprove this assertion. 
It certainly happens not infrequently that both mother and 
child are constipated, and, if the child is nursing, one is 
tempted to consider this coincidence as cause and effect ; but 
the same thing happens frequently in the case of children 
who have never been nursed by their mothers. If we assume 
in such cases a hereditary influence, it must be one that ante- 
dates the birth. The fact is that the causes of chronic con- 
stipation are not always easily recognized nor always readily 
amenable to treatment. As we have said once before, any 
physician who keeps accurate accounts of the peculiarities of 
the families he treats can tell of individual peculiarities 
which seem independent of ordinary conditions. For in- 
stance, one parent is habitually constipated, the other never 
has a hint of it. One child is ''as regular as clockwork,** 
while the other scarcely ever has an evacuation without some 

253 



254 THE CENTURY BOOK FOR MOTHERS 

remedy or assistance. Yet the hygiene of this particular 
family may be as uniform as possible. At the table they 
all eat the same meals, except that the constipated ones may 
eat less of the constipating food than the others. The cause 
must lie in some difference of the nervous and muscular ac- 
tion of the bowels. 

If milk is still the principal part of the child's diet, 
it will be advisable to add a tablespoonful, or even more if 
the milk is rather thin, of cream to each glass of milk the 
child drinks. The porridges of oatmeal so commonly used 
help, by their bulky refuse, to relieve constipation, and their 
effect is increased by the addition of cream to the milk. 
Bread made of whole wheat (Graham or other unbolted flour) 
is preferable to white bread. As regards fruit, peaches are 
excellent. A little later, good pears and apples may be 
given ; they should, however, always be scraped with a spoon. 
In winter, one may give the juice and pulp of the orange, 
which is about the only usefiil uncooked fruit obtainable, but 
various cooked fruits may be given. Of vegetables, spinach, 
cauliflower, asparagus, and celery are admissible. They 
must be fresh, thoroughly cooked, finely cut, and the spinach 
should be made into a good puree, not served as ''greens" in 
country style. 

MAGNESIA AS A LAXATIVE 

Is there any harm that can possibly be done by giving a child 
magnesia? I was advised to use it in the cream food in 
place of the lime-water, on account of its laxative effect. 
Baby, eight months old, is badly troubled with constipation. 
I put about half a teaspoonful into each of the five or six 
feedings per day. , 

Magnesia is probably not so harmful as was formerly sup- 
posed. It is soluble and laxative only in combination with 
some acid, which acid may be met in the alimentary canal. 
The older physicians always gave warning of the danger of 
masses forming in the bowels. This may have occurred, but 



CONSTIPATION 255 

must have been very rare, as magnesia has been given very 
freely as a domestic remedy. On the other hand, it is not a 
desirable remedy. If a laxative antacid be desired, bicar- 
bonate of soda has all the advantages of magnesia, without 
its alleged disadvantages. 



CONSTIPATION IN A "BOTTLE BABY" 

Will you please tell me what I can do to relieve my baby of con- 
stipation? He is four months old and has always been trou- 
bled with it. For a long time I was obliged to use a soap sup- 
pository or water injection very frequently. My physician at 
last prescribed something, but I find I must give it very fre- 
quently to keep the passages normal. 

I have been obliged to use a bottle for him almost from the first. 
I have used cow's milk entirely for him. Do you think it 
may be harmful to continue the use of suppositories and in- 
jections ? 

To answer offhand is more than we can do. Constipation 
is an extremely common ailment in infants, particularly if 
bottle-fed. How much you have diluted the cow's milk and 
with what we do not know. Possibly the constipation would 
yield in part to the freer use of sugar and cream with the 
milk. So, too, usually the use of oatmeal gruel, not too 
finely strained, for dilution of the milk is often somewhat 
la^xative. 

As to medication, we prefer for habitual use the introduc- 
tion of a suppository or an enema to the administration of a 
laxative. The soap pencil, the pencil of molasses candy, and, 
most efficient of all, the glycerin suppository are very use- 
ful. Very often the most persistent care is necessary to keep 
the bowels relieved until the child is old enough to eat and 
digest a mixed dietary. "We have followed a good many 
children who were troubled with constipation in infancy, 
and found them entirely and satisfactorily regular by two 
and a half to three years of age. 



256 THE CENTURY BOOK FOR MOTHERS 

CASTILE SOAP SUPPOSITORIES; CANDY SUPPOSITORIES 

Don't you think suppositories of Castile soap are preferable to 
those of bar-soap? The old-fashioned molasses suppositories 
work more kindly with my children than anything else for 
constipation. 

The Castile soap has the advantage over other soaps of being 
usually a well-made and bland soap and less irritating, and 
it is so far preferable. There are children, however, whose 
bowels seem to need the stimulus of the coarser variety. The 
candy suppository has ''the wisdom of our fathers" in its 
favor. 

OBJECTIONS TO SUPPOSITORIES; THE EFFECT OF 
MASSAGE; THE VALUE OF REGULAR HABITS 

In my experiences with two very constipated children I found 
that the use of soap and a roll of paper induced piles — quite 
as great an evil as constipation. 

My method, which entirely cured my babies of constipation, was 
to rub and knead the bowels with oil thoroughly every night 
and morning, and to put them on the stool at a regular time 
each day. With this treatment I adopted a laxative diet for 
myself, and when they were weaned gave them as much lax- 
ative food as possible. 

I am persuaded that the use of soap, stick-candy, or paper, 
which produces an irritation of the rectum, is not always wise. 

Your experience of course justifies your abandoning the sup- 
positories; but, judging from considerable personal experi- 
ence and the reports of many others, the soap rarely has 
such an effect. There are some persons (adults) so sensi- 
tive as to complain of being irritated by so unirritating a 
thing as a well-oiled syringe nozzle, but this is rare. One 
source of irritation in the use of suppositories is the press- 
ing too firmly in introducing them. If the point is intro- 
duced into the seat, and a very little time is allowed to elapse 
before pressing further, the first spasm of the muscle re- 



CONSTIPATION 257 

laxes, and the pencil is readily introduced. The soap is 
often made less irritating by scraping it and forming a sup- 
pository of the scrapings. This is introduced easily and is 
not hard. We have never known real piles (as distinguished 
from an irritation of the anus) produced by the use of any 
of the suppositories recommended, but we accept your diag- 
nosis. 

The regulation of the mother's diet is important. The 
friction and kneading of the bowels have some value, but 
in the regularity of putting the child upon the stool you have 
touched the most important point of all. Of course, it is 
inapplicable to very young infants, but in adult life, as well 
as in childhood, the rigid following of this rule often cures 
constipation without any medicinal treatment at all. There 
is excellent physiological reason for it, which we cannot go 
into here. 

THE EFFECT OF AN ENEMA 

Will you kindly tell me if the habit of giving babies, for con- 
stipation, enemas of warm water twice a day is an injurious 
one, or if it is apt to lead to serious inactivity of the bowels? 

The question might be restated thus: Is an enema twice a 
day more or less harmful than allowing the bowels to remain 
unmoved or than some other remedy? It hardly need be 
said that any remedy, whether medicine, suppository, or 
enema, is objectionable if an evacuation can be obtained by 
such natural stimulants as laxative food or exercise; but if 
something must be given, then what? The objection to the 
enema is the possible dilatation of the lower bowel, and a 
greater tolerance of retained matter. The choice is gener- 
ally between an enema and a suppository. Once a day is less 
objectionable than twice. 



17 



VII 
VARIOUS DIGESTIVE DISTUR^NCES 

A PROBABLE CASE OF "DYSPEPSIA" 

Could you quiet my great anxiety by telling me whether a child 
who only recently began speaking through her nose will 
of herself lose that trouble? She has been sick with de- 
rangement of the stomach, and is always very constipated; but 
since three weeks ago she is up again, though her tongue con- 
tinues coated. Ever since she has been sick she speaks dread- 
fully through her nose, and often picks at it, too. When I make 
her repeat her words loudly it sounds less nasal, but we should 
feel greatly troubled were she always to speak so. She has 
since her illness grown very thin, and every moment attempts 
to clear her throat in a way which is painful to listen to. The 
doctor said it is a nervous freak; she once before had it, last 
spring, but lost it later, so I am not quite so much worried 
about it as I then was. She seems weak, and toward evening 
always appears tired out. She is four and a half years old, 
and has for almost two years not taken afternoon naps. I 
have of late tried to have her again sleep afternoons, but with- 
out avail; she only lies down and rests that way. Mornings, 
when she first wakes up, she complains of pains in her head, 
and similarly when she goes to bed. Invariably after she falls 
asleep, and is asleep half an hour or so, she cries out as if 
scared; but we can soon quiet her. Is that habit, or is there 
some distinct cause for it? 

This child is evidently still ill, although less so than she has 
been. She has still, as enumerated, a catarrh of the nasal 

258 



VARIOUS DIGESTIVE DISTURBANCES 259 

passages and throat, foul tongue, debility— most marked to- 
ward evening— morning headache, and broken sleep. A 
child in that condition needs systematic care by a physician, 
and should not be treated by the parent alone. By this we 
do not mean that the physician must see her often, but he 
should prescribe for her, either seeing her or being informed 
of her condition at fixed intervals (to be fixed by him) until 
she is better. If we were to guess at the child's ailment, we 
should say that she had Avhat is usually called "dyspepsia" 
—that is, a disordered condition (catarrh) of the stomach 
and upper intestine. Proper treatment will cure it, and 
make her sound again. The nasal symptoms Avill improve 
with the rest; but if anything remains of them, local treat- 
ment of the catarrh will be very helpful. Sprays of listerine, 
or some other disinfectant which your physician may rec- 
ommend, will probably be of decided benefit. 

HABITUALLY COATED TONGUE 

Can you suggest a remedy for an habitually coated tongue? 
My little boy is three years of age, has a fair appetite, and 
lives mostly upon milk, with the addition of some fruit and 
vegetables, a little meat, and simple puddings. I have con- 
sulted a physician concerning his diet, who advised not giving 
any meat while the tongue remained coated, also no sweets. 
I tried this, but it did not seem to make any great difference. 
He is an unusually active child, sleeps well at night, and also 
takes a nap through the day. He weighs thirty-six pounds and 
measures thirty-seven inches in height. 

Your physician's advice was in accordance with the ordinary 
understanding of such cases, and is probably correct. There 
are instances of tongues habitually slightly coated or whitish 
which do not appear to have any concomitant disturbances 
of moment ; but these are exceptional. Ordinarily the coated 
tongue is supposed to be associated with a deranged state of 
the digestive organs, especially the stomach. And the re- 
strictions of diet suggested by your physician are usually 



260 THE CENTURY BOOK FOR MOTHERS 

demanded to insure a cure, even if other measures need to 
be taken. 

EXCESSIVE PERSPIRATION OF THE HEAD AND 
OTHER SIGNS OF RICKETS 

My baby boy perspires a great deal. Often, especially after the 
noonday sleep, his pillow is quite wet. I think that this ex- 
cessive perspiration causes his hair to come out, as he does 
not seem to have as much now — at the age of six months — 
as he had some time ago. His head is quite large. He is 
pretty strong and heavy for his age, and there seems to be no 
trouble with his digestion, although his stomach is large and 
generally quite hard. 

There is a popular belief that excessive perspiration of the 
head causes loss of hair, but we doubt whether the two are 
really cause and effect; their relation, we suspect, is that 
they are both effects of a common cause. Several disorders 
of nutrition may cause a large abdomen or a large head, but 
when both are present, with the peculiar symptom of sweat- 
ing of the head, it is extremely probable that the trouble is 
rickets— a condition in which the system does not appro- 
priate sufficient phosphate of lime. It is an ailment that 
is quite common, but also very commonly overlooked, unless 
it goes very far. It is, fortunately, quite easily controlled 
by proper diet and treatment, but is not within the scope of 
domestic medicine. A competent physician ought, by all 
means, to prescribe a suitable diet for your child. 

THE USES OF BICARBONATE AND PHOSPHATE 
OF SODA FOR WEAK DIGESTION 

Will you kindly enlighten me on the following points? My 
baby boy, fourteen months old, has always been small and 
delicate. He was weaned two months ago, and on account of 
his extremely weak digestion I was obliged to add an alkali 
to his milk, which I dilute with one third strained oatmeal. 
On account of his habitual constipation I use carbonate of 



VARIOUS DIGESTIVE DISTURBANCES 261 

soda instead of lime-water. I received the suggestion from a 
good authority, but I am aware that both lime-water and soda 
were recommended "temporarily to counteract acidity." Xow 
I am becoming anxious about continuing to add the soda, 
though I still fear to omit it. 

Please inform me whether its continued use may be injurious 
to my little one, and enlighten me as to what bad effects it 
would produce. 

Is phosphate of soda an alkali ? 

The persistent use of any drug should be avoided, unless 
there is evident reason for its administration. As to the 
bicarbonate, Ave should say that it is, perhaps, as little harm- 
ful as any. But its use is chiefly as an antacid, rather than 
a laxative. It is put into milk only to make sure that the 
latter is not sour, and to prevent too sudden curdling. It is 
safer to have blue litmus-paper in the house, with which to 
test the acidity of the milk, and to add the soda or not, as re- 
quired. Blue litmus-paper is reddened by any liquid having 
an acid reaction. The druggist -who sells you the paper will 
explain its use to you. The sudden curdling is perhaps bet- 
ter prevented by the addition to the milk of barley or 
oatmeal-water, which act, as is supposed, by mechanical hin- 
drance to the formation of large curds. Soda has a medici- 
nal value also if the stomach secretion is believed to be too 
acid (it is acid naturally), which is evidenced by hard or 
large curds or uncommon acidity in the vomited matters, or 
similar curds in the passages. All alkalies, if abused, are 
supposed to have the effect popularly called ''thinning the 
blood," but the soda salts are generally better tolerated than 
those of potash. 

Phosphate of soda has a slightly alkaline reaction, but it is 
not counted as an alkali. It is a useful laxative or purgative, 
according to dose. 

"LIVER TROUBLES" 

I wish to solicit your opinion regarding inherited liver troubles. 
Can they be outgrown? And will any particular diet aid the 



262 THE CENTURY BOOK FOR MOTHERS 

cause? Milk in any form known to me will induce an attack 
in both my babies. 

We answer your question rather doubtfully, because we are 
not sure that we know what is meant by ''inherited liver 
troubles." ''Liver troubles," "liver complaint," and the 
like are popular phrases, probably inherited from the medi- 
cal speech of previous generations, which now have no defi- 
nite meaning. We think that they are generally used to 
express a catarrh of the stomach or upper intestine. But 
from w^hat you add we suspect that you mean an inability 
to digest milk without difficulty. 

The development of the digestive powers is such as gives 
ground for hoping that, as this power strengthens, the ability 
to digest milk will be increased. But w^e may add that a real 
inability to digest milk if properly taken is very rare indeed. 
There is a very general disability to digest milk if it is con- 
sidered as a drink, and not as a food. We mean that people 
take or allow their children to take milk with other food as 
they would water, disregarding the fact that it is itself a 
very highly nutritious food. We often see children at table 
who, having already eaten enough, pour into their stomachs 
a glass or two of milk, alone enough for a good meal, and 
often cold enough to arrest all digestion. The result is very 
usually such a catarrhal attack as is called "bilious." One 
of the ways in which the inability to digest milk is "out- 
grown" is by learning this simple rule: Take it for food, 
not for drink ; take it slightly warm as you would any other 
food, and do not make young children (i. e., under a year 
and a half) try to eat undiluted cow's milk. 

DOMESTIC TREATMENT OF SUMMER COMPLAINT 

Can you publish some remedy for the domestic treatment of 
summer complaint? I am going North with my youngest 
child, a baby of eleven months, who is inclined to bowel trou- 
bles, and am anxious to be provided with the proper reme- 
dies for an emergency. 



VARIOUS DIGESTIVE DISTURBANCES 263 

Against an emergency it is well to have in the house some 
chalk mixture, or, better yet, the compound chalk powder, 
as the mixture is apt to spoil in hot weather; also a very 
small vial of the compound tincture of catechu and another 
of paregoric. A mixture can then be made as needed, thus : 
Take a level teaspoonful of the chalk powder and mix with 
six of water; rub or stir thoroughly together, until no lumps 
exist, then add a teaspoonful of the catechu tincture and mix 
thoroughly. The dose of this mixture for a child of one 
year will be a teaspoonful, and to each dose five drops of 
paregoric may be added. The paregoric is not mixed with 
the other ingredients, as it is frequently desirable to stop the 
paregoric while the medicine is continued. Little children 
sometimes show marked susceptibility to opium poisoning; 
hence the effect of each dose is to be noted, and if drowsi- 
ness appears the paregoric should be omitted ; otherwise, the 
dose can be given every two hours if the purging continues. 
It ought to be stated that these drugs are not to take the 
place of other measures which the physician will indicate. 
The suggestions are intended only for use in case a physi- 
cian is not readily at hand. 



APPARENT OVERFEEDING 

My little girl, four weeks old, seems to be troubled with indiges- 
tion. She spits up so much after nursing that it seems 
scarcely possible that her stomach has retained any of the milk. 
Then almost immediately she is hungry again. I nurse her 
quite regularly every two and a half hours, and seem to have 
plenty for her. Sometimes the milk is curdled when she raises 
it, but more frequently not. 

She is troubled and restless after nursing, and often cries out 
when spitting up. She weighed seven and three quarter 
pounds when born, and now weipchs ten and one half 
pounds. Her bowels move three or four times in twenty-four 
hours; the color is good, but there are curds in the move- 
ments, and she almost always cries before the bowels are 
moved. Those I have consulted say, "spitting up makes a fat 



264 THE CENTURY BOOK FOR MOTHERS 

baby," and "it is healthy," but it does not seem to me to be 
right. Can you advise what is best to do? 

The symptoms are very suggestive of over-distention of the 
stomach. A child at four weeks can rarely take comfort- 
ably more than two fluid ounces (four tablespoonf uls) , and 
if your flow of milk is large, and particularly if it contain 
a good deal of solid matter— butter, casein, etc.— the regur- 
gitation would very likely follow. If the trouble still con- 
tinues, see that she gets smaller meals. The repeated de- 
mands for food are the results of the indigestion, not of 
normal hunger. 

INDIGESTION; DILUTION OF MILK CALLED FOR 

My baby boy is just six months old, has one tooth, and another 
visible. I nursed him partly until five months; since then he 
gets pure cow's milk, sterilized, lime-water in every bottle, 
each bottle holding six ounces. His meals he gets regularly, 
three hours apart. He has always, with the exception of the 
last few weeks, been well, his digestion having been perfect 
until lately, but now he has stool sometimes five and six times 
in twenty-four hours, and he has no appetite whatever; his 
sleep also has been restless since teething began. 

Ought I to put cream in his milk; what can I do for his appe- 
tite; must I change his food, and if so, what shall it be? 

A child of six months usually cannot safely take pure (i. e., 
undiluted) cow's milk. The average baby of twelve months 
finds it more than he can digest. You ought certainly not to 
add cream, unless to a much diluted milk. We favor ' ' cream 
foods," but they are not made by adding cream to milk 
alone. One of the best has this composition: Milk, four 
tablespoonf uls ; cream, six tablespoonfuls ; water, twenty 
tablespoonfuls ; milk-sugar, a tablespoonful slightly heaped. 
After sterilizing, add two tablespoonfuls of lime-water. 
This, as you see, makes a pint of food. But you can prob- 
ably do better than that now by simply diluting the milk 



VAEIOUS DIGESTIVE DISTURBANCES 265 

■\\dth an equal bulk of boiled water, the lime-water to be in- 
cluded in this amount of water. Probably his appetite will 
improve when his dietary is more suitable. 

PAREGORIC FOR GREEN MOVEMENTS 

Is the use of paregoric harmful if given for green movements, in 
doses of five drops in half a teaspoonful of water every two 
or three hours ? How much may be given in that way ? 

It may not be harmful, but it does not attack the cause of 
the green stools, it only diminishes their frequency. The 
green stools usually are over-acid, and the green color is be- 
lieved to be due to a microbe which flourishes in them. The 
purification — or disinfection — of the intestinal canal is essen- 
tial to success. The drugs best suited to this you would not 
be able to select wisely, and you should rely upon your 
physician for them. 

THE CAUSES OF DIRT-EATING 

My baby boy, who is now twenty-six months old, has for months 
had the habit of eating dirt, when playing out of doors. Is 
there something lacking in his food? I have always been 
very careful about what he eats. Until he was fifteen months 
old I gave him only sterilized milk. Since then he has had 
bread and milk, bread and butter, rice, and soft-boiled egg. 
Last summer I gave him a little fruit. Can you tell me why 
he persists in the habit I have mentioned? 

The morbid appetite is not rare, but usually is found in 
connection with disordered digestion or a disordered ner- 
vous system, and, in adults at least, in connection with the 
hysterical peculiarity. Examine in these directions for a 
cause. 



VIII 
ERUPTIONS 



THE CHARACTERISTICS OF MILD AND 
OF SERIOUS ERUPTIONS 

Is there any way of telling the difference between a little harm- 
less rash — heat-rash, so called, for example — and that of scar- 
let fever, measles, etc.? If it was the beginning of a severe 
case, of course the other symptoms would make themselves 
known ; but how would it be in a light case, and with an infant, 
who could not tell its feeling? 

I have a little nephew, about three months old, who, when his 
mother was just about to bathe him one morning, exhibited a 
slight rash. She was rather in a dilemma, not knowing 
whether it amounted to anything or not, and whether she 
should give the baby his usual bath and send him out for his 
airing in the carriage, or call in her physician. She finally 
decided that it did not amount to anything, and her judgment 
in this case proved correct; but what if she had been wrong 
and the result serious? 

The differences are not easy to describe in words, and it is 
said that in hot Aveather even physicians have mistaken Ger- 
man measles and some other eruptive disorders for prickly 
heat. The most striking distinction to the untrained eye 
between scarlatina and prickly heat we think is the eleva- 
tion of the eruption of prickly heat above the skin. It is 
composed of minute conical elevations Avith or without a 
watery liquid in a vesicle at the top, and the inequality can 
be recognized by passing the fingers over the surface. The 

266 



ERUPTIONS 267 

eruption of scarlatina is made of minute bright red points, 
afterward coalescing, appearing first on the neck, and then 
on the chest, and spreading, and brightest where covered. 
Measles has a duller red eruption, which appears in cres- 
centic patches around the ears and on the face first, and is 
brightest where exposed. German measles looks more like 
measles at first, and then more like scarlatina. Prickly heat 
is most abundant on or confined to parts where the clothing 
retains the perspiration. It comes almost exclusively in hot 
weather. The eruptive fevers are more prevalent in the 
cooler season— f. e., the season of closed and un ventilated 
houses. 

"DRIVING IN" ECZEMA 

Is it really dangerous to try and heal eczema on a child's face? 
My baby was afflicted with it until eight months old, and I 
was warned not to attempt to heal it, as that would "drive it 
in" and produce some form of sickness as a result. Our physi- 
cian prescribed zinc ointment (which did no good), and said 
the ailment would probably last until baby had all her teeth; 
then it would pass away. At grandmother's suggestion, how- 
ever, I tried a mild solution of salt and water when washing 
baby's face, following that each time with talcum powder, and 
this did more good than anything else. Then we went to the 
seashore, where baby had the salt air and sea-water for a final 
plunge after each bath (the chill taken off by the addition of 
plain hot water), and within a couple of weeks the eczema had 
disappeared. We remained by the sea until baby was ten 
months old, and the eczema has never returned in the same 
degree, but only in occasional patches during the cutting of a 
tooth or some little disorder of the stomach, such as babies 
have. If there is danger in curing the eczema ordinarily, why 
did no ill results follow the natural cure performed by the sea ? 

There is no danger whatever in treating an eczema ; it cannot 
be *' driven in." The blunder— a very wide-spread one popu- 
larly—came about thus: Eczema sometimes depends upon 
constitutional conditions that vary their points of manifesta- 



268 THE CENTURY BOOK FOR MOTHERS 

tion; when a new point is attacked the eczema sometimes 
disappears. So, too, it is a very common observation that two 
diseases rarely will go on actively at the same time; hence 
it has been observed that an eczema has disappeared when 
an internal disease in no way connected with it has been set 
up. In such cases the eczema might be said to be "called 
in," rather than ''driven in." 

Eczema and other skin diseases should be always healed 
as soon as practicable. The notions about "driving in" 
eruptions are ordinarily simple superstitions, and at best 
are founded on the misapprehension of cause and effect. 
AVhen a severe illness occurs eruptions sometimes fade, and 
the careless observer thinks that the illness was caused by 
the disappearance of the skin disease, when the reverse was 
the truth. We may, however, say that such eruptions are 
often very obstinate and hard to cure. 

HEAT-RASH 

My little girl, twenty months old, is much troubled with heat- 
rash. We bathe her with bicarbonate of soda and water, and 
use zinc or lycopodium powder, but neither seems to do her 
any good. Can you recommend any different treatment? 
Would it be well to use vaseline? She has lately been having 
a good deal of bowel and stomach trouble, but that is ac- 
counted for by the fact that she is just getting her stomach 
and eye teeth. We feed her, by our doctor's advice, on oat- 
meal gruel and milk entirely. Is barley equally nutritious, 
and would it be less heating to her blood ? Would it be well for 
her to wear linen or lawn next her skin under her thin merino 
shirt? The rash usually comes out on her face and neck with 
every warm spell, but this time it is all over her body, and I 
don't know what to do for it. 

Derangement of the digestive tract often increases the sus- 
ceptibility of the skin, and anything that relieves the former 
will in so far help the other. Just what things your child 
needs in this way your physician can best say. The heat- 



ERUPTIONS 269 

rash is usually kept up by the excessive perspiration, and 
the lessening of the latter is also helpful. Limiting as far 
as possible the child's activity of course will diminish per- 
spiration ; sometimes the use of alkaline drinks is useful, but 
they should not be employed without the consent of the 
physician who is familiar with her stomach trouble. Again, 
light and loose clothing— which may at the same time be 
sufficiently warm to prevent chilling— is very useful, the 
worst irritation from heat-rash usually being at points where 
the clothing binds. The lawTi or linen shirt under the 
merino is often useful in allaying friction. Barley is of about 
the same nutritive value as oatmeal, but less laxative. Some 
persons find oatmeal ''heating," in the sense of favoring 
eruptions, but this is not the rule. 

RED-GUM 

My baby girl is six months old to-day. She is plump and usu- 
ally good. At the age of two months she had red-gum, and it 
was some weeks before she recovered. It (the rash) remained 
the longest and brightest wherever the wet napkin touched, 
and even yet comes and goes there. An orange stain is often 
present. The opening into the bladder is also a bright red. 
She has been of a very constipated habit, but by giving her a 
little "brown-bread coffee" I now secure a daily movement. I 
have been able for over a month now to see four teeth, the 
upper front ones, but they are not yet through. 

My hope is that you can give me definite directions as regards 
her urine, and also tell me when and how I had best wean her. 
I have plenty of milk, when I can get milk myself to drink (just 
now the people with whom I am boarding have but little), and 
have nursed her regularly until six weeks ago, every two hours 
in the day — once at night — and since then every three hours. 

The "red-gum" and the present rash are not, strictly speak- 
ing, the same, but that is a point of small moment. The 
eruption under the napkin is very common, especially if the 
urine be very acid, as it probably is when the orange deposit 



270 THE CENTURY BOOK FOR MOTHERS 

is present. To correct this tendency (which is probably due 
to peculiarities of digestion) in a child on the breast is not 
easy. Something may be done by giving her water, and we 
think the condition will probably improve, since you have 
adopted the three-hour rule in place of the two-hour interval, 
which was continued too long. Locally, washing the parts 
with weak alkaline washes— e. g., lime-water, or very weak 
soda solution— will allay irritation. If the skin is irritated, 
great care should be exercised in cleansing the parts fre- 
quently, carefully drying them and powdering or dusting 
them with fuller's earth or similar preparations. 

PSORIASIS 

Will you give me some information regarding psoriasis in young 
children ? My little girl, six years old, who is perfectly healthy 
in every other respect, has been disfigured with this disease for 
more than three years. 

Can the disease be entirely eradicated, and, if so, how long is 
it likely to take? 

Is there any particular period of life when it can be most favor- 
ably treated? 

What effect have eruptive fevers, such as chicken-pox and mea- 
sles, on the disease? 

As relapses of psoriasis are very common, and as the erup- 
tion varies at different times in the course of a year, dis- 
appearing and reappearing, it is not easy to say how often a 
permanent cure is effected. The particular attack may be 
cured, but the tendency to return may still be present. For 
this reason no specific answer can be given to the ques- 
tion as to duration of treatment. But this much can be 
safely said, that some cases remain cured for as long a 
time as the physician is able to follow them, and that the 
treatment may require only a few weeks, or may be very 
tedious. 

It should be treated as promptly as possible, and, as age 
does not seem to materially influence its appearance, it can- 



EBUPTIONS 271 

not be said to influence the time at which treatment will be 
particularly efficient. 

Probably no permanent effect. One eruption will compli- 
cate the other temporarily. 



SEBORRHOEA 

Can you tell me the cause of or the cure for the scurf which 
sometimes forms on babies' heads? It is not exactly like dan- 
druff, being soft and yellow, but forms in small scales about 
the size of dandruff. With my three children it begins to 
appear when the new hair begins to come off. It scrapes off 
easily when rubbed with vaseline, but forms again in a week 
or two. My nurses have told me never to comb or scrape it 
off, but no one seems to be able to tell me of any other way 
of getting it off or any way of preventing its coming. After 
the hair gets long and thick it seems to become dry, more like 
dandruff, though still yellow in color. 

The trouble is doubtless what is known as seborrhoea. It 
has a greasy form and a dry form, the latter being called 
dandruff. Your child appears to have the greasy form, as 
is usual in infancy. There are some superstitions still sur- 
viving against the removal of this so-called "cradle cap," 
but they are only superstitions. The cause of the disease 
is an over-activity of the glands which normally secrete the 
sebaceous, or unctuous, matter of the skin. The cure of it 
lies in keeping the skin clean by shampooing with poap or 
slightly alkaline solutions, and afterward applying stimulat- 
ing lotions. Various practitioners have their favorite for- 
mulas. 

RINGWORM 

My little boy, four years old, has a "ringworm" on his forehead 
about one inch and a half in diameter. I have used a prepa- 
ration of potash, and it seemed to stop it for a while. I am 
now painting it witb iodine, but it does not seem to do much 
good. Can you tell me what causes it, and bow I can cure it? 



272 THE CENTURY BOOK FOR MOTHERS 

It cannot be hereditary, for I am perfectly healthy, and have 
never had anything like that, nor has his father. 

Ringworm is not hereditary. It is due to a vegetable para- 
site which grows upon the skin. The cure consists in allay- 
ing the inflammation and killing the parasite to the last spore. 
The tincture of iodine is usually successful if persisted in. 
It must be painted over all the changed parts of the skin. 
Daily frictions with green soap— a kind of soap much used 
for skin diseases— are useful, and any germicide not too 
strong will help. One of the safest for domestic use is the 
hyposulphite of sodium. Dissolved in five parts of water, it 
may be applied locally. On the face care should be taken 
not to use too strong applications, as slight scars may be 
caused. 

HERPES AND ITS CURE 

Can you tell me something about the skin disease herpes, also 
the most effectual remedy, and if it is likely to return when 
occurring in a child of nearly two years who has still to get 
her eye and stomach teeth, and if there is any preventive 
measure to be taken? 

The name herpes is an old one, and was applied to a number 
of quite diverse ailments. The ailments to which it is now 
restricted by most writers are of small importance. One of 
these is the eruption called "cold sores," occurring about 
the lips. Cleanliness and a soothing salve like cold-cream 
generally end the matter. Possibly you may mean some 
other disease of the skin; zoster, or shingles, for instance, 
was once classed as herpes. 



"BLACK-HEADS" 

I wish to ask your opinion regarding a certain condition of the 
skin, in the case of my little daughter, which is unpleasant 
to behold. I refer to the choking-up of the little glands on 
the forehead and around the mouth, which become blackened 



ERUPTIONS 273 

and are known as "black-heads." Then the pores of the skin 
of the nose are enlarged, and minute fatty particles can be 
pressed out. This gives to the skin a greasy look. I have 
asked my physician about the cause, thinking perhaps it was 
an impurity of the blood. But he claims it is not, and that 
he knows of nothing to remedy it. I have kept the pores of 
the skin of the whole body open by frequent bathing, think- 
ing that might be of benefit. Sometimes she has little eleva- 
tions which are like little pimples, but when they are squeezed 
out it is just the same fatty substance which exudes — not pus. 
I would state that her diet has been carefully watched, and 
only the simplest food allowed. Are these appearances of the 
skin, especially the little fatty pimples, due to the state of 
the blood? What course of treatment could you advise me to 
pursue in order to have the pores of my little girl's face clean, 
pure, and healthy? 

The ailment is easily recognized. The medical name of the 
eruption is comedo. The natural sebaceous follicles are filled 
or distended with their secretion (sebum), and the dark head 
is caused by the deposit of dust, or possibly, as some think, 
by a formation of pigment. The situations most generally 
affected are the nose and its neighborhood, the forehead and 
temples, and the upper part of the back. 

Constitutional treatment is sometimes necessary, but ordi- 
narily purely local treatment suffices. It consists first of 
squeezing out the contents of the follicles. This may be done 
with finger-nails, better by means of a large watch-key, or, 
still better, a small cylindrical tube with a smooth end, which 
is less likely to injure the skin. The hollow end is placed 
over the "black-head," and smart, abrupt pressure forces 
the latter out of the follicle. 

Directly after the use of the instrument on the various 
points the parts are to be bathed with hot water to diminish 
the irritation. In addition, the glands are to be stimulated 
by the daily use of good soap. If this proves too irritating, 
warm bran-water in which a little borax is dissolved may be 
used. If the skin is unpleasantly shiny after the use of soap, 

18 



274 THE CENTURY BOOK FOR MOTHERS 

rub it with a soft flannel or lightly powder it. But, except 
among ladies, this shininess of the skin is rarely considered 
worth notice. 



THE CAUSE AND CURE OF HIVES 

Will you kindly tell me if there is any cure for hives? I have 
a little boy, now eighteen months old, who is perfectly healthy 
in every respect, bnt is greatly troubled with hives, and has 
been since his birth. He has only commenced to take solid 
food within the last two months. I can't observe that his diet 
has much to do with it. He appears to inherit the trouble 
from me. 

It should be mentioned that the term "hives" is a popular 
name for several disorders of widely different character. 
First, it means croup, especially catarrhal croup. This appli- 
cation of the term seems to be not common in America, but it 
survives in the popular remedy for croup now passing out of 
use— "hive-syrup." Secondly, the name is applied to vari- 
ous skin eruptions, and particularly to urticaria, or nettle- 
rash. In answering we shall assume that this last is the dis- 
ease meant by our correspondent. 

Both the scientific and popular names just mentioned are 
derived from that of the stinging nettle (several species of 
urtica), which produces this eruption if it touches the skin, 
at least in many persons. The eruption is composed of 
wheals, raised above the surface a sixteenth of an inch or 
more, which are white or pink and surrounded by a red 
blush. Ordinarily they are not much larger than a finger- 
end or a cent; in severe cases they form large patches, and 
it is not rare to see the face swollen by them until it resem- 
bles the face of one afflicted with an erysipelatous inflam- 
mation. The outbreaks are usually quite sudden, and often 
they as quickly subside. Many persons are very subject to 
the disorder, particularly those of a nervous temperament. 

The causes are various. External irritations of many 



ERUPTIONS 275 

kinds may excite it. Besides the nettle, which stings by its 
minute sharp hairs, many stinging insects cause it. A stroke 
of a whip-lash is a well-known instance of an external irri- 
tant causing the wheal. AYe have seen persons whose skin, 
particularly after a bath, would rise in the track of a sim- 
ple pressure of a finger-tip. The skin of some persons is 
chronically in this state of excitability. 

Internal causes are also very various. Most common of 
all is a sensibility to certain things taken into the stomach, 
some of which affect many persons. Of these the most fa- 
miliar are fish, oysters, clams, lobsters, crabs, and berries, 
notably straAvberries. Less frequently vegetables, such as 
cucumbers and mushrooms, may be the offending food, and 
some persons are affected by eggs or honey. Many persons 
are affected only at certain seasons or occasionally, others 
pretty uniformly by some particular article of diet. The 
peculiarity does not seem to be always connected with an 
indigestion, as the effect is sometimes too prompt, occurring 
almost before the food is swallowed. There are many drugs 
which produce urticaria in susceptible people. 

Now, to effect a cure is often extremely difficult ; often, 
on the other hand, very easy. This depends in part upon 
the varying character of the ailment as to pertinacity and 
upon the good fortune of the physician in ascertaining what 
is the particular cause in any given case. The successful 
remedies may, for the greater part, be classed under three 
heads: (1) Those which clear the intestinal canal of the 
offending substance, if food seems to be the cause of the 
trouble. The household remedy of rhubarb and soda, or 
rhubarb and magnesia, maintains its place among such. (2) 
Remedies which act as antiseptics upon imperfectly digested 
or fermenting food. Among the most popular of these are 
sodium salicylate and sulphurous acid, or the sulphites. (3) 
In cases more or less chronic, tonics, especially Peruvian bark 
and its derivatives, are very useful. 

For the temporary alleviation of the itching, sponging 
with an alkaline solution (soda and water), or with alcohol, 



276 THE CENTURY BOOK FOR MOTHERS 

or the rubbing on of an ointment containing chloroform, 
seems to be as successful as anything we know. 

The main point, however, is to find out the cause, and in 
the case of your baby we think the most probable source of 
mischief lies in the intestinal canal. An occasional clearing 
out of the bowels with the rhubarb and soda, and possibly 
a tonic, will be the safest plan. 



IX 
COMMON DISEASES 

PRECAUTIONS IN A CASE OF DIPHTHERIA 

Our little three-year-old daughter is just recovering from a se- 
vere attack of croupal diphtheria. She is hoarse and coughs 
a good deal. Her stomach troubles her, and she is very rest- 
less at night. She eats very little, mostly milk with bread or 
oatmeal gruel strained. I know nothing about the after- 
treatment of diphtheria. Perhaps you could enlighten me on 
the following points: 

How long is it before the danger of infection is over? We 
have kept our baby away from her, and it is now one week 
since she began to mend. 

How long does the throat remain inflamed usually and the 
hoarse cough continue? She cannot speak plainly yet. 

What are the symptoms of a relapse? 

What is the best preventive against the infection of others and 
also the recurrence of the disease with every cold, etc. Some 
recommend belladonna. 

In case of paralysis and other after-troubles, what is best to 
do until medical aid can be procured? 

Is a change of climate always desirable when it can be had? 

No one can answer this question categorically. Assum- 
ing a genuine diphtheria, contagion is possible as long as 
any of the poison is about, and it may cling to clothing or 
articles of furniture for a long time. After the sick child 
is pronounced thoroughly well it should be carefully bathed, 

277 



278 THE CENTURY BOOK FOR MOTHERS 

its hair cleaned, and its clothing all changed, and taken to 
another room— not yet to other children— while the sick-room 
and its contents are fully disinfected. The child should 
be kept away from other children for some days longer at 
least. 

Often a long time— the time is so variable that to state 
an average would be rather a guess than a rule. 

A real relapse consists in the reappearance of a mem- 
brane somewhere. If it is low down in the throat the symp- 
toms may be those of croup. If higher up, or on the ton- 
sils, or in the front part of the nostrils, the membrane can 
be seen, or if high in the nostrils it can be inferred from the 
kind of discharge. Scientifically speaking, there is a relapse 
or reinfection whenever the bacillus of diphtheria reappears 
in any of the mucous surfaces after having once been absent. 
These bacilli often persist, however, for a long time after 
apparent recovery. The case is not cured so long as they 
persist, and it may still cause infection of others. Until ''a 
clean culture" is obtained the case is dangerous. 

The disinfection and care described above is the best safe- 
guard. There is no tendency for it to come back "with 
every cold," unless the poison of diphtheria is lurking 
around. Belladonna probably has absolutely no effect on the 
poison. It is, however, useful for some sore throats. 

The domestic treatment of the paralysis is practically noth- 
ing, except nutrition— careful feeding little by little to 
avoid choking, if the throat is the seat of the paralysis. For 
the paralysis of the limbs we know of no domestic treatment 
to be recommended. 

A change of climate— to a healthful one— if the change 
can be accomplished without too great fatigue, usually is of 
value in promoting recovery from debilitating ailments. It 
is not called for in diphtheria more than in other diseases, but 
change might prove beneficial by removing the patient from 
the influence of the special pt)ison which had been left unde- 
stroyed in the home, and which often causes reinfections, as 
shown by cultures made from the throat. 



COMMON DISEASES 279 



GENERAL EXPERIENCES WITH ANTITOXIN 

What is the present status of antitoxin as a remedy against 
diphtheria? One sees so many contradictory accounts of its 
effects in the newspapers that an authoritative opinion will 
doubtless be welcome to many readers. 

This is about the present status: As regards the results in 
hospital practice there is some disagreement, but we believe 
that the prevailing opinion is distinctly in its favor. Some 
of the most active antagonists of the use of antitoxin seem 
to have made up their minds in advance of experience, and 
to have collected only such evidence as would aid their pre- 
conceptions. 

Some time ago the American Paediatric Society, believing 
that the real test of the value of the remedy would be made 
in private practice, determined to collect all the evidence it 
could concerning its use by general practitioners. At the 
meeting of the society in Montreal the committee reported 
the results of the investigation. Several hundred physicians 
had contributed their experience. All doubtful cases of 
diphtheria were omitted, leaving about fifty-five hundred un- 
mistakable ones. The results were very encouraging indeed, 
and the most enthusiastic reports were from practitioners 
whose previous experience had been most disastrous. 

It is not pretended that the antitoxin, even of the best 
quality, is a ''sure cure" for diphtheria. There are many 
reasons why it cannot be ; but that it is a very potent remed}^ 
outweighing in value any other, and probably all others, as 
against the disease per se, now seems a fair statement. It 
does not and should not displace all other proper treatment, 
medical and surgical, but it does make its results more favor- 
able, and nowhere, we think, is this more striking than in 
cases of diphtheria of the larynx, where some interference 
on the part of the attendant has become necessary. In this 
connection the society above mentioned collected further evi- 
dence, with similarly reassuring results. 



280 THE CENTURY BOOK FOR MOTHERS 

ANTITOXIN AS A PREVENTIVE AND CURE 

What is your opinion of the value of antitoxin as a preventive 
of diphtheria? Do you approve of giving it in all cases of 
diphtheria ? 

The value of antitoxin is more manifest every year. With 
the early recognition of the disease by bacterial culture, and 
the prompt use of antitoxin in all suspected cases, the deatht- 
rate from diphtheria has been wonderfully reduced ; for in- 
stance, in the city of Boston to less than ten per cent. The 
efficiency of the antitoxin is very much greater if given early 
—that is to say, as a preventive of the development of the 
poison in the system, than as a cure for its ravages. Its 
value as a preventive of the disease in those exposed but not 
manifestly infected is fully demonstrated. To the writer's 
mind, the use of the antitoxin, if obtainable, is imperative 
in all cases of diphtheria, and also in all threatening cases 
in which the diagnosis has to wait for bacteriological proof. 



QUESTIONS AS TO DIPHTHERIA AND MEMBRANOUS 

CROUP; POPULAR MISCONCEPTION 

OF MEDICAL TERMS 

Is there any difference between diphtheria and membranous 
croup, and is the latter contagious? And is it only allopathic 
physicians who consider them identical? 

We may say at starting that so far as we know there never 
was any school of physicians calling themselves allopathic 
or allopaths. But by a singular misuse of words the name 
is popularly applied to those who do not accept the doctrines 
of homoeopathy or any other pathy. The special point asked 
about has never to our knowledge been made a distinctive 
one between any schools of medicine. 

The identity of diphtheria and membranous croup has 
\ very much discussed for many years, and the opinion 



COMMON DISEASES 281 

has varied very much with time. Physicians who were in 
practice about thirty-five years ago— the time that diphtheria 
first reappeared in this country after a very long absence- 
pretty generally considered it as a very diflt'erent disease 
from the then well-known membranous croup. As time has 
passed, this opinion has lost ground, and has nearly dis- 
appeared. We doubt if the question can be absolutely de- 
cided. But without any intention or desire to dogmatize, 
we may say that our own notion is this: That the mem- 
branous croup of forty years ago was not diphtheritic in our 
present sense of a disease due to the Klebs-Loeffler bacillus ; it 
was rather a rare disease as compared with diphtheria to- 
day, and the evidence of its contagiousness was wanting. 
On the other hand, to-day a membranous laryngitis (croup) 
is practically always diphtheritic, the change probably being 
due to the general diffusion of the diphtheria poison. There 
are many kinds of sore throat characterized by a membrane- 
like exudation, concerning the nature of which a good deal 
of doubt and difference of opinion exists among those well 
qualified to judge. Thus, there are many cases which every 
one pronounces diphtheria ; other cases which every one is 
equally sure are non-diphtheritic; but between are many 
kinds of tonsilitis concerning which a guarded opinion must 
be given, unless one takes the short and easy method of class- 
ing them all together as diphtheria— a method which tends to 
magnify the repute of the user, as a vast majority of his 
cases will get well. 

We may mention one term only to condemn it : It is 
'* diphtheritic sore throat." If any disease is diphtheritic it 
is diphtheria; if it is not diphtheria it is not diphtheritic. 
If the physician is not sure of its nature he should have the 
courage and honesty to say so, and not hide behind a tricky 
phrase. The danger of using it lies in the proneness of peo- 
ple to be misled by a meaningless name, and neglect necessary 
precautions. Every doubtful case of throat disease should 
be treated as dangerous until a culture proves it to be not so. 

In leaving the subject, we may mention a similar dan- 



282 THE CENTURY BOOK FOR MOTHERS 

gerous blunder in the supposition that scarlatina is a mild 
or innocuous form of scarlet fever. Scarlatina is simply the 
Latinized technical name for scarlet fever ; the blunder prob- 
ably arises from mistaking the termination ''ina" for a di- 
minutive. Scarlatina is neither more nor less than scarlet 
fever. 

CROUP 

Please state the difference between false croup and real croup. 
There seems to be much confusion on the subject. Many per- 
sons speak of "croup" simply, when evidently false only is 
meant. Is not the real croup a very dangerous sickness, and 
false croup a comparatively harmless one? 

Any disorder which produces a peculiar change in the sound 
of the voice and the cough, and which is attended with more 
or less difficulty of breathing, is called croup. But the kinds 
usually thought of when the name is used are the catarrhal 
or ''false" croup, and the membranous or "true" croup. 
The term "spasmodic" croup is applied properly to a spas- 
modic disease of the larynx {laryngismus stridulus, or "child 
crowing"), but carelessly to the "false" croup mentioned 
above. The "false" croup is a catarrhal laryngitis, and the 
symptoms are due to the temporary changes in the mucous 
membrane of the parts. It is, as you suppose, attended with 
more alarm than real danger. In "true" croup a fibrous 
membrane forms in the larynx or windpipe, upon the surface 
and more or less in the substance of the mucous membrane. 
This membranous croup is at the present time usually con- 
sidered to be of diphtheritic origin, and some physicians be- 
lieve that it always is and always was diphtheritic, but this 
is a disputed point. This ' ' true ' ' croup is a very dangerous 
disease. Besides the dangers from obstruction in the larynx 
and windpipe, it entails all the other dangers of diphtheria. 
The "false" croup is one of the manifestations of a "cold" 
in some children— called popularly "croupy." It is cer- 
tainly more likely to occur in improperly fed children. 



COMMON DISEASES 283 

The term ''croupous" is in medical parlance applied to 
a fibrinous exudation occurring on a mucous membrane in 
any situation ; thus, that type of pneumonia which has such 
an exudation is called croupous pneumonia. 

CHARACTERISTICS OF MALARIAL DISORDERS 

Can you tell me what is the matter with my little girl? She is 
two and a half years old, and large and strong for her age, but 
on several occasions she has complained early in the afternoon 
of feeling very tired, and has wanted to lie down; she has then 
become very sleepy and flushed, and has nearly got into a 
kind of stupor, lying with her head and face almost buried in 
her pillow, and with her knees drawn up to her chest; this is 
accompanied with fever, and every now and then she has been 
sick at her stomach, and has then fallen off again into the 
same state, from which no noise will rouse her; toward night 
she gets cooler, and in the morning wakes up much better and 
quite bright, but still a little flushed and feverish. She has 
had these attacks three times ; the second time it lasted a week, 
and every day was nearly a repetition of the previous one; the 
last attack lasted about two or three days. 

I have had a doctor's advice, but with apparently little result, 
and I should like to know what is really the matter, as I fear 
a recurrence of the attack. I feed the child on meat every 
second day, and only give a little of it to her with potato; her 
other diet consists of bread and milk and bread and butter, 
with light puddings, and nothing else. The strange part of 
the attack is this repetition of the fever and sickness at the 
same hour each day, and the apparent entire relief from it in 
the morning. 

The stupor and other symptoms doubtless depend upon the 
rise of temperature. This may be due to a multitude of 
causes. But the distinct periodicity of the attack would 
make the diagnosis of intermittent fever a very probable 
one, although as regards children we are very shy of using 
the words "intermittent," ''remittent," or "malarial," as 
they are made the cloak of a world of ignorance. Intermit- 



284 THE CENTURY BOOK FOR MOTHERS 

tent fever is the most distinct of malarial disorders. In a 
typical case in an adult the chill which announces a paroxysm 
occurs with considerable regularity— daily, on alternate days, 
or less often, according to the variety of the fever. A fever 
with a daily access is called a quotidian ague; one with an 
access on alternate days is a tertian ague, and so on. But 
in childhood the frank chill is less common and the fever is 
less regular than in adults. And herein lies the danger of 
error, since in most diseases of childhood the temperature is 
more subject to fluctuations than in adults. An irregular or 
paroxysmal fever may arise from a multitude of causes, and 
may be — indeed, often is — classed as "malarial" or "remit- 
tent" simply from the temperature range, while the mala- 
rial poison has nothing whatever to do with it, and the real 
cause behind the fever may be overlooked and its treatment 
therefore neglected. Many physicians do not in a doubt- 
ful case make a diagnosis of malarial disease until they 
have after proper search failed to find any other reasonable 
cause. 

Fortunately, the true malarial fevers are usually quite 
amenable to medical treatment, and quite recently it has be- 
come possible by examination of the blood to make a clear or 
probable diagnosis in cases formerly very difficult of deter- 
mination. 

REMEDIES FOR MALARIAL FEVER 

I have a baby, nine months old, who for almost two weeks has 
had chills every other day. I had one, and I suppose he took 
the start from me, but he still has them. I have taken an 
abundance of quinine, and have rubbed him with it, and the 
day before his last one I had the doctor inject some in his 
arm and give him a solution of quinine three times, but it 
did not keep the chill off. However, I will give him more of 
it again. I hate so much to give quinine; the acid put in 
to dissolve it curdles his milk, and it is such a fearful dose 
to take. I would like to know if there is not something more 
simple that will do the same good. I liave always nursed him, 
and he has always been well. Before he was sick he weighed 



COMMON DISEASES 285 

twenty-four pounds, which I think is good weight for a baby 
of that age. 

There is no meaning that we can understand connected with 
the adjective ^'simple" as popularly applied to remedies. 
The ancient meaning of a ''simple" remedy was, as nearly 
as may be expressed, an herb or vegetable remedy supposed 
to have a "simple" or specific curative powder over some dis- 
ease or upon some organ. The bark from Avhich quinine is 
gained would have been a typical example. But (and this 
is why we emphasize it) practitioners are not a little both- 
ered by importunities for some "simple" remedy to do this 
or that, the meaning being, so far as can be guessed, to ask 
for a remedy which shall be very potent against the disease 
or unpleasant symptoms, but entirely devoid of any other 
effect. All of which is as wdse as the seeking for a gunpow- 
der which shall be of the greatest power in propelling the 
ball and w^hich shall produce no recoil of the gun. 

As applied to your case, this means that, while quinine is 
in many ways— to some more than to others— a remedy of 
very disagreeable action, yet it and the kindred alkaloids 
associated with it in Peruvian bark are, far and away, the 
best remedies we have against malarial fever. It may be 
mentioned that the hydrochlorate (muriate) of quinine can 
be dissolved without the aid of acid. Yet the bark and its 
derivatives sometimes fail, for reasons not easy to under- 
stand. The remedies next in esteem are arsenic, Warburg's 
tincture, blue gum, probably in about the order named. 
It is very difficult in many cases to break up a malarial 
fever while the patient remains in the region where the dis- 
ease has been acquired. But patience wdth the treatment 
will probably effect a cure. It is probable that a more gen- 
eral recognition of the agency of certain mosquitoes as the 
conveyers of a malarial-poisoning organism will render it 
easier to prevent these persistent occurrences. So far as we 
now know, malarial poisoning always started (not counting 
relapses) from the bite of a mosquito. 



286 THE CENTURY BOOK FOR MOTHERS 

THE CAUSES AND TREATMENT OF TYPHOID FEVER 

I should be glad to have your opinion about the general treat- 
ment of those who have had typhoid fever, and to know if you 
think that there is any special care required, say, six or seven 
months after recovery, either with grown persons or chil- 
dren. 

While on this subject can you advise me where to get any know- 
ledge of how typhoid fever is caused or taken? It seems to 
me that the treatment of typhoid has made wonderful strides, 
but as far as I can judge from my experience with the faculty, 
they are as far from knowing the origin of typhoid in the 
patient as ever. It is said that it must be taken inwardly, as 
through milk or butter or something of that kind; and others 
say from the excrement. Many cases, however, have been 
known where it was from none of these. 

The recovery after typhoid seems in some cases to be prettj^ 
prompt. Often, however, it is very slow, taking months, and 
even years, before the last traces of its damage are gone. 
Each case must be judged by itself, and the error, if any, 
should be on the safe side. 

Any recent work on the practice of medicine will prob- 
ably tell you all you need to know— not a controversial pam- 
phlet, but a text-book "up to date," which is meant for the 
use of practitioners. Probably you could borrow one from 
your own physician. We think the origin of typhoid fever 
is much better known than anything else about it. We know 
that it comes from just one poison, and we know by sight 
the peculiar bacillus which is, or which manufactures, that 
poison. The method by which that poison is introduced 
into the system in a given case may be uncertain, but often 
when we are acquainted with the surroundings of the patient 
in the past the doubts are solved. Unfortunately, in a 
great proportion of cases, even in intelligent circles, nothing 
accurate can be learned as to where the patient had been or 
what he had done. It is true that the poison is mainly, al- 
most exclusively, passed from the body in the stools; it is 



COMMON DISEASES 287 

true that infection of water and food is generally through 
infected stools. The links are often lost, but in cases where 
epidemics have been sufficiently important to excite research 
it has almost uniformly been found that the circle has been : 
An initial case; infected stools so disposed of as to infect 
water; this water, drunk or mixed with food or used to 
wash vessels to be used for food. A recent epidemic in a 
town near Xew York was confined to the patrons of one milk- 
man, whose premises Avere found to be infected. Sadly 
enough, some of the patients confined themselves to a diet of 
the very milk which was bringing them the poison, before it 
was discovered. One case, it is said, occurred in a person 
not a patron of this dairy, but he had drunk milk when 
taking a meal at the house of a patron. Suppose this person 
had gone elsewhere before sickening, and that the epidemic 
had not been sufficiently important to awaken inquiry, a 
fresh epidemic might have been started, the origin of which 
would possibly have remained a mystery. Similarly, we 
have had epidemics from oysters taken from the water near 
the mouths of drains. 

SYMPTOMS OF TYPHOID FEVER 

Please tell me something of the symptoms of typhoid fever. 
In what way do they differ from the symptoms of ordinary 
fever ? 

As the phrase ''ordinary fever" conveys no meaning to the 
writer, the symptoms of typhoid only can be mentioned. 
These have been well studied in adults, and in them make a 
pretty distinct picture of disease. The principal symptoms 
of the onset of typhoid are decided lassitude, with headache, 
coated tongue, and loss of appetite, and very often with nose- 
bleed, the severity of the symptoms increasing gradually until 
after a few days or a week the patient is obliged to take to 
the bed. The temperature meantime, and perhaps for a week 
longer, gradually climbs, rising at night, letting up a little 



288 THE CENTURY BOOK FOR MOTHERS 

mornings, but with a gradual ascent which has been com- 
pared to a flight of steps. There are usually abdominal 
symptoms, such as gurgling and tenderness, often— probably 
more often than not— diarrhoea and about as frequently a 
peculiar eruption of rose-colored spots, especially on the back 
and abdomen. Let this slight sketch stand for the adult 
type of typhoid. The infantile tj^pe varies from it con- 
siderably. 

In the first place, typhoid is of exceeding rarity under 
the age of two years. From that to five it is still excep- 
tional, but from five to ten years it is not uncommon, and 
after this later date the type is nearly the same as that of 
adult life. But the cases which occur between, say, two and 
ten years— both dates approximately stated— have the peculi- 
arities which are usually considered distinctive of typhoid 
much less pronounced. The fever, for instance, is less likely 
to come on with the insidious ascent before described. It 
is more likely abrupt in its onset. With it are often symp- 
toms of disordered stomach, such as vomiting, and the case 
might easily be taken for an acute gastric disturbance. The 
diarrhcea is more likely to be absent, and if present to be 
mild. The eruption is less frequent and less marked, and 
the fever is, on the average, of somewhat shorter duration 
than with older children or adults. The depression, however, 
is much the same. 

It will be seen, therefore, that the peculiarities of typhoid 
in childhood are not very striking, and the diagnosis must 
often be made by the physician by the aid of blood tests and 
the like. The only lesson for the nursery guardian is: In 
any case of continued fever have medical advice. 

THE USUAL SYMPTOMS AND TREATMENT OF 
SCARLET FEVER 

Please describe the usual symptoms of scarlet fever. How long 
does a simple case last, and what is the recognized mode of 
treating it? 



COMMON DISEASES 289 

The ordinary striking symptoms are vomiting, usually with- 
out nausea, and sore throat, with fever. The onset of symp- 
toms is sudden. The throat, and the roof of the mouth as 
well, is quite red, and in the latter situation the redness is 
made up of very fine dots, much as is the skin eruption when 
it comes. The fever varies Avith the severity of cases from 
perhaps 101° to 105°. The eruption follows in a variable 
time, but as a rule it is from a half-day to a day and a half. 
It usually is first seen upon the neck and breast, but 
the whole skin should be examined. It spreads rather 
quickly over the whole body, and continues for a variable 
time, but in the great majority of cases this time is between 
three days and a week. The desquamation or peeling being 
an essential part of the disease, the latter must be considered 
to continue as long as any desquamation exists, which may 
b^e from one to two months. Probably five or six weeks will 
cover most cases. 

There is no recognized treatment special to this disease. 
Rest in bed and the relief of symptoms as they arise suffice 
for mild cases. The essentials of treatment in ordinary cases 
are to meet symptoms and await their natural disappearance. 
Severe or complicated cases may call for a great deal of medi- 
cal care. The treatment of a case of scarlatina should never 
be assumed by any one without medical guidance, if the latter 
be obtainable. Baths are extensively used in the treatment 
of the disease, but even these should be specifically directed 
if possible. Sequels follow even the mildest cases, and these, 
as well as the severe ones, should be carefully watched and 
isolated. 

CHARACTERISTICS OF MEASLES 

Can one always tell whether a child is going to have measles or 
scarlet fever? What is the best domestic treatment for 
measles ? 

Measles usually begins with a cough and catarrhal symptoms. 
But these do not show that the child is going to have measles, 

19 



290 THE CENTURY BOOK FOR MOTHERS 

but that he already has it. In scarlet fever the onset is 
abrupt. If, as may be the case among non-professional peo- 
ple, only the eruptions are considered the disease, then the 
earlier stages (see p. 145) may give the Avarning. But to 
the medical man these symptoms are as essential as the rashes. 

The best domestic treatment is to send for the doctor. If, 
after examining the case thoroughly, he believes that it can 
be left to domestic care, he will give directions as to that 
care, and also indicate the symptoms that will demand his 
attention. 

One of the principal dangers in the treatment of even 
mild cases of scarlet fever and measles without professional 
guidance is the non-recognition of complications and sequels. 
Those in scarlatina are commonest in the shape of throat and 
ear troubles, kidney inflammation, and the so-called scarla- 
tinal rheumatism. All of these complications may induce 
secondary ones, and the watching of a case of scarlatina is 
never a light task, even to the physician. 

The complications and sequels of measles are more strik- 
ingly manifested in the respiratory and the digestive organs. 
Measles often awakens latent lymphatic troubles, and the eyes 
may remain tender (chronic conjunctivitis) for a long time. 



GERMAN MEASLES OR ROTHELN 

Does a child that has Gerraan measles require any treatment? 
Is this trouble always easy to recognize, or does it not some- 
times resemble real measles? 

This disease, of which the scientific name is rubella, has been 
definitely recognized as distinct from measles and scarlatina 
only in comparatively recent years. Its name, ''German 
measles, ' ' shows that it has been considered a variety of mea- 
sles. In fact, it is a disease by itself, although it does resem- 
ble, especially in its eruption, sometimes measles, sometimes 
scarlatina; much more often the former. 

One of the most striking peculiarities of the disease is its 



COMMON DISEASES 291 

variability of appearance, and very experienced physicians are 
often obliged to base their diagnosis rather upon the concomi- 
tant circumstances and the prevalence of the disease (for it is 
one that is rarely, if ever, seen except in epidemics) than upon 
the appearance or history of the individual case. A fair de- 
scription of an average case would be something like this : An 
eruption is discovered on the face, or even covering the whole 
body, without any previous signs of illness, although fever, 
catarrhal symptoms, vomiting, etc., may have existed. The 
eruption consists of slightly raised reddish spots, usually not 
more than an eighth of an inch in diameter. It generally 
begins on the face, runs over the body, and goes off in the 
same order, and is gone in about three days. Usually the 
spots do not run together and the fever is slight, lasting 
about two days. The ''peeling" of the skin rarely amounts 
to much. Physicians usually expect to find some swelling 
of the glands, particularly in the back part of the neck. 

While exceptions do occur, it is true that the disease rarely 
kills or even is attended with severe complications or after- 
troubles. Therefore, if the disease is certainly recognized, 
little treatment in the sense of medication is called for. Pain- 
ful or distressing symptoms may require attention. If they 
do not occur, good nursing will meet all the requirements. 
But careful regimen and nursing go far to prevent these 
untoward symptoms and complications, and should always be 
employed. It is obvious that isolation of the cases is de- 
sirable. 



THE CAUSES AND CHARACTERISTICS OF RHEUMATISM 

How can one recognize rheumatism in young children? What 
causes it? 



Rheumatism is a term of such wide and vague meaning that 
it has been seriously proposed to banish it from medical 
nomenclature. For our purpose we will take it to mean that 
disorder known as rheumatic fever, or acute rheumatism. 



292 THE CENTURY BOOK FOR MOTHERS 

In adults this disease is characterized by a good deal of fever, 
painful and swollen joints, and many other well-known signs. 
In children, especially if young, the symptoms are not so 
striking. If the child can talk, it probably will complain of 
soreness in joints or muscles. If it be too young, it may show 
signs of pain on handling. There is usually moderate fever. 
The symptoms are unfortunately often overlooked, or called 
''growing pains." "Growing pains" are pretty certainly 
something else than what they are called, and should not be 
neglected, as a sad lot of heart lesions come from them. 
Whenever a child complains of pains, especially if it has 
tonsilitis or a tendency to nervous twitching (chorea), it is 
fair to consider it a case of rheumatism. The cause of rheu- 
matism, according to what Ave think is to-day the prevalent 
opinion of those best able to judge, is an infection, probably 
microbic. The matter is still under investigation as well as 
discussion. 

THE CONTAGIOUSNESS OF MUMPS 
Is mumps a very contagious disease? What is the treatment? 

It is probably one of the most contagious disorders. Treat- 
ment, beyond making the person comfortable, is rarely needed 
in uncomplicated cases. As the person cannot chew and 
swallow without some discomfort, food should be liquid and 
bland. Owing to the contagiousness, the patient should, if 
possible, be isolated until quite well. Unfortunately, the con- 
tagiousness seems to last a long time. 



THE VALUE OF GARGLING IN SORE THROAT; 
DIFFERENT KINDS OF SORE THROAT 

Do you advise gargling for sore throat? 

How can one tell whether an ordinary slight sore throat will 

not develop into a serious one? 
Please mention the different varieties of sore throat and their 

symptoms. 



COMMON DISEASES 293 

Gargling is a convenient method of applying remedial liquids 
to that part of the throat which is not far back. It is of 
small account in the pharynx. The solutions are better ap- 
plied anywhere by means of an atomizer making a fine spray. 

No one can tell. Some of the points which help to dis- 
criminate diphtheria from other forms of tonsilitis are given 
on page 139. 

The varieties of sore throat are almost as numerous as the 
infections causing disease. If divided according to locality, 
there are tonsilitis, pharyngitis, etc. If according to appear- 
ance, one could divide again. Thus, for tonsilitis, there are 
simple tonsilitis, follicular or lacunar tonsilitis, diphtheritic 
tonsilitis, suppurative tonsilitis, or quinsy, etc. If accord- 
ing to cause, sore throat may be rheumatic, gouty, diphthe- 
ritic, scarlatinal, etc. It is easy to see that to detail the symp- 
toms of each would take a goodly chapter. 



ST. VITUS'S DANCE 

Please describe the symptoms of St. Vitus's dance. What is the 
cure? 

The one characteristic symptom is that with which probably 
every one is familiar, even in childhood— namely, the erratic 
convulsive movements of the patient, winking of the eyes, 
convulsive twitchings of the face, jerkings of the hands and 
arms as well as of the lower limbs, and contortions of the 
body. It varies greatly in degree. The treatment is largely 
hygienic, both physical and mental, and, medicinally, tonic. 
It is not a good ailment for domestic experimentation. 



SIGNS OF HEART TROUBLE 

If a child gets out of breath and has sometimes a rapid pulse, 
are these signs of incipient heart trouble? What are the 
usual symptoms? 



294 THE CENTURY BOOK FOR MOTHERS 

It is not easy to give precise answers to questions which have 
no precise meaning. The symptoms mentioned might be due 
to a genuine heart disease, meaning valvular disease, or to a 
faulty action of the heart due to anemia, or merely to the 
excitability of the heart's action often seen when the fault is 
somewhere else. The term '^ incipient" is hardly applicable 
to heart diseases— the genuine ones. 

ALCOHOLIC STIMULANTS IN FEVERS 

My little girl of five years has the scarlet fever, and our physi- 
cian prescribed for nourishment milk punches every two hours. 
I would like your opinion on the subject of giving spirituous 
liquors to children in cases of fever. I am under the impres- 
sion that whisky and like stimulants only add fuel to the fever. 

Alcoholic stimulants, properly used, do not "add fuel to the 
fever." The condition demanding their use is not one that 
can be discussed without a good deal of knowledge of physi- 
ology and pathology. Every judicious physician considers 
alcohol as a drug to be given or withheld in any case, pre- 
cisely as any other drug, according to the circumstances that 
exist and the ends to be accomplished. The unfortunate 
abuse of alcohol leads the laity as well as some physicians 
to treat it as if it were a thing by itself. The abuse of opium 
and other narcotics, of quinine, or of purgatives is no reason 
against their proper medicinal use. So with alcohol. If 
you can trust your physician with other drugs, you may with 
this. 

THE VALUE OF COD-LIVER OIL IN CASES 
OF SCROFULA 

My child is six years old, very heavy and fat, but weak and very 
pale. She goes to a kindergarten. Her appetite is queer; 
sometimes she eats very little and sometimes too much, and 
then mostly bread, very little or no meat, and vegetables none 
whatever. I have doctored with her and been to hospitals. 
The physicians say she is scrofulous and needs cod-liver oil. 



COMMON DISEASES 295 

and will be stronger when she is a year older. She has always 
had a very bad cough, owing to bronchitis. I have given her 
cod-liver oil for over a year, bat notice no improvement. She 
still coughs very badly, and at night when she coughs she 
sweats. Is cod-liver oil a good remedy and the only remedy 
in such a case? 

It is quite probable that the opinion that has been given 
you is correct— namely, that the child is scrofulous— and that 
she has had, and still has, bronchitis. The rearing of such 
a child entails much patient care upon the mother, but in 
the end it is usually successful. Cod-liver oil is not the only 
remedy, but is, perhaps, more important than any other one. 
Besides, it would appear that she should have some remedy 
to stimulate the appetite, and to relieve the cause of its fit- 
fulness, which probably is a disorder of the stomach. The 
paleness suggests that she needs iron also. We do not, how- 
ever, think it desirable for you to try to pick out the appro- 
priate medicines yourself. It would be better worth Avhile 
for you to ask your physician about these points. 



A CASE OF TAPE-WORM IN A FOUR-YEAR-OLD CHILD 

I am very much troubled over a case of "tape-worm." Our little 
girl has been troubled with this for nearly two years. We 
have given repeated treatments of fern, pomegranate, and 
pumpkin seed. Our physician does not suggest any other rem- 
edy. Can you tell us of something that will help us in any 
way? Are there specialists in this line; if so, will you kindly 
name them? 

Please give me all the information concerning "tape-worm" that 
you can — the best remedy and how to apply it. 

We may say in starting that we know of no ''specialists" in 
this line among reputable physicians. Some have studied 
the parasites of the human body with great care, as a matter 
of science, but they have promptly put their knowledge at the 
disposal of the profession. 



296 THE CENTURY BOOK FOR MOTHERS 

Three tape-worms are well known as living in the human 
intestines. Of these the broad tape-worm is rare in this 
country, and practically is found only in immigrants from 
certain parts of Europe. The other two, called the beef tape- 
worm and the pork tape-worm (from their ordinary source in 
human food), are not uncommon, the beef tape-worm being 
the most frequent of all. The life history of one of these crea- 
tures is, in a few words, this : The excrement of a person suf- 
fering from tape- worm is carelessly put upon fields, or in some 
place where cattle or hogs may swallow the embryos of the 
worm contained in the discharges. After reaching the diges- 
tive tract of the animal the development of the embryos begins, 
and they travel through the tissues until they make a lodg- 
ment, most commonly in the flesh or liver, both used for hu- 
man food. The flesh so infected is popularly called ' ' measly. ' ' 
If the meat were thoroughly cooked these partially devel- 
oped worms would die ; but much meat is eaten raw (bologna 
sausages, etc.) or imperfectly cooked. The larva is set free 
in the digestive organs of the person eating the meat and 
begins to grow. The differences in the appearances and de- 
velopment of the two species are too slight to interest the 
non-professional reader. In fact, until quite a recent period 
the two were considered as one. There is one difference, how- 
ever, worth mentioning : The tape- worm from beef is usually 
solitary, of that from pork quite often several are found in one 
person. This fact, not generally insisted on, may, we think, 
sometimes explain the supposed failure of treatment— that is 
to say, only one worm of several has been killed, and vigi- 
lance relaxed prematurely. Probably only an expert could 
decide from small parts of the Avorm to which species it be- 
longed. The segments of the pork worm, however, are usu- 
ally thinner and less opaque than those of the beef worm. 
The segments of the latter are more likely to creep out of 
the bowels than are those of the pork worm. 

The three remedies you have tried are all excellent, and 
usually effective. Besides them, kousso and oil of turpentine 
should be mentioned. The latter is one of the most certain. 



COMMON DISEASES 297 

Whatever remedy is selected, its use must be preceded by 
several days of fasting or as scant a diet as can be borne. 
Neglect of this preliminary often is the cause of failure. The 
dose of the medicine selected and the preparation must be 
determined by the physician to suit the peculiarities of the 
patient, as most of the efficient drugs have some draAvbacks 
which must be guarded against. It is nearly always neces- 
sary to follow the administration of the special remedy by a 
purge. Last of all, it is necessary to remember that after 
many failures success may be gained by perseverance. 



THE CAUSES OF MENINGITIS 

Will you please state the probable causes of meningitis in its 
various forms, also whether there is any safeguard against so 
fatal a disease in young children? 

In the case of children meningitis is usually caused by some 
infection. Probably the most common is tubercular. The 
epidemic cerebro-spinal meningitis seems to depend upon 
several kinds of micro-organisms, especially several kinds of 
cocci, including that which causes pneumonia. Meningitis 
may occur as a complication of most of the eruptive fevers, 
influenza, etc. 

The only preventive is the avoidance of the diseases with 
which it is associated or which it follows. 

Injuries to the head sometimes occasion simple meningitis. 



JAUNDICE; BILIOUSNESS 

Is it unusual for a child of five to have jaundice? 
What can be done for biliousness ? 

Jaundice is one of the rarer conditions in young children. 

If by ''biliousness" is meant an attack of gastro-intestinal 
catarrh, the treatment is not one for domestic practice. If 
that word is intended to mean the tendency shown by some 



298 THE CENTURY BOOK FOR MOTHERS 

persons, young and old, to such attacks, the prevention must 
lie in a careful dietary, avoidance of indigestible articles of 
food, as well as of excess in the use of proteids and fats, regu- 
larity of the bowels, and good general hygiene. 



HYDROCEPHALUS, OR WATER ON THE BRAIN 

How can one recognize early enough the distressing disease 
known as "water on the brain"? What is the proper treat- 
ment for it? 



The name ''water on the brain" is a popular one, and has 
been applied to more than one form of inflammation of the 
brain membranes (meningitis), with collection of liquid. We 
do not know which you have in mind in asking your ques- 
tion. The chronic form, called hydrocephalus, is most read- 
ily recognized by the increased size of the head, which is a 
pretty constant symptom. This often reaches such a degree 
that the child cannot hold up its head. If the enlargement 
begins early and advances rapidly, the functions of the brain 
are interfered with, the acuteness of the intelligence and of 
the special senses being impaired, with other nervous mani- 
festations. In slowly progressing cases this is often not so; 
but in any case death usually occurs in the early years. 

There is another and more frequent disease called "water 
on the brain, ' ' or acute hydrocephalus, which is the tubercu- 
lar form of meningitis. The early symptoms of this disease 
are not pronounced nor certain, and are more often recol- 
lecte«l after the disease is recognized than noticed at the time. 
These beginnings may be mistaken for some other disease, or 
the reverse. But after a time distinct brain symptoms ap- 
pear, such as stupor, convulsions, dread of light, screaming, 
etc., one alternating with another, with some fever. It is 
not worth while to detail the painful sequence of symptoms 
that conduct to the fatal end, which as a rule comes in from 
one to four weeks. 

As to the treatment, nothing need be said. Many years 



COMMON DISEASES 299 

ago the writer heard a distinguished medical lecturer say, 
"The only reason we have for treatment is the hope that we 
have made an error in diagnosis. ' ' If recovery from a genu- 
ine attack of the disease ever occurs, it is so rare that the 
most experienced observers express their doubts of its exist- 
ence, and many frankly say that they have never seen it. 

THE CHARACTERISTICS OF HERNIA 

My little boy, now twenty-one months old, has a protrusion of 
the navel about one quarter of an inch, or the size of a large 
bean. It has been so since he was three months old. I put a 
compress on it while he wore bands, but it did no good. 
Finally, I discarded both band and compress, and it grew no 
worse; neither does it improve. It was not caused by crying. 

What treatment would you advise, if any? I have read that 
rupture of the navel should be cured before the age of three 
years, or the cure would be difficult. 

I do not consider my little boy's rupture very bad, but it ought 
not to exist at all. Do you think there is a probability that 
it will grow worse if not attended to? 

First examine the protrusion to see if it be really a rupture, 
and not one of the naturally protruding navels. This you 
can probably determine (if not, your physician can) by ob- 
serving whether the protrusion contains anything that can be 
pushed back within the body. This movable part, if it exists, 
constitutes the real hernia. If it is a real hernia it ought to 
be attended to. 

THE CAUSES OF RUPTURE 

What causes rupture? People tell me carelessness of the nurse. 
What form of carelessness? 

Rupture is caused by the combination of some effort of strain- 
ing acting upon one of the naturally weak points of the abdo- 
men. The navel and the groins are in infancy the usual 
points. We believe that in infancy it is commonly due to the 



300 THE CENTURY BOOK FOR MOTHERS 

fact that the children who are ruptured are less strongly 
built at these places of danger than are other children. We 
know of no form of ' ' carelessness of the nurse ' ' likely to cause 
rupture. The binders often put on by nurses through mis- 
taken care we think more likely to do harm than good. The 
blame is put upon the nurse because the ordinary person can- 
not conceive that his or her baby could have a weak spot. 



TREATMENT OF HERNIA 

Is hernia ever cured in a boy three years old by wearing a truss, 
and, if so, what kind of a truss would you advise? Ought a 
child so afflicted to be allowed to romp and play as other chil- 
dren do? 

Hernia is sometimes cured by a truss. The kind must be de- 
termined by the needs of the ease, and the treatment neces- 
sarily demands a long time. The child should be restrained 
in its games only so far as regards those involving special 
strains. For it seems to us that to make a self-conscious in- 
valid of a little child is worse than an uncured hernia. A 
gameless childhood is dreary indeed, but we ought to add 
something more than your inquiries strictly call for— namely, 
that at the present time the truss is not our only recourse. 
If it does not do its work satisfactorily, a radical operation 
can be performed which in good surgical hands is safe and 
in a great proportion of cases successful in making a real 
cure. 

TREATMENT OF A PROTRUDING NAVEL 

Will you tell me if a navel extending about three quarters of an 
inch needs special attention? What is the effect of the rup- 
ture on the child, and what, if anything, must be done to 
cure it? It does not seem to trouble him, and the family physi- 
cian says it needs only a tight flannel band, but I object to 
tight bands and use the knitted ones. If an appliance is 
needed, is a home-made one of value? 



COMMON DISEASES 301 

Ordinarily, a navel which protrudes three quarters of an inch 
in a child three months old does need attention. There are 
occasional exceptions. The effects of a rupture if neglected 
are usually not great at first, some pains and discomforts per- 
haps being all ; but whoever has a hernia carries a threat of a 
sudden and fatal peritonitis from the possible strangulation 
of the hernia. Besides, even if no dangerous results happen, a 
hernia is always an added burden to carry through life. Your 
physician advises the flannel band for a particular reason; 
you have no right to set up your preferences against his 
judgment, at the risk of grave results to the child. If you 
doubt his judgment, or if his treatment is not efficient, try 
some other physician, but do not neglect the navel unless you 
are assured by the present physician, or some other good one, 
that there is no hernia. 



FALLING OF THE BOWEL 

Can you advise me what to do for falling of the bowel in a 
young child? What can be done to prevent it? 

The falling usually occurs at stool. To prevent it, keep the 
bowels free, so that straining is unnecessary ; also, if the ten- 
dency to fall is marked, it may be better not to set the child 
upon the chair, but to let it have its evacuations in its nap- 
kins in a recumbent posture. Or, if the chair is used, do not 
let it sit a long time. As soon as the evacuation has occurred 
wipe and wash the parts, and then, with the fingers anointed 
with vaseline or some other unguent, press the bowel upward, 
the central part first, as that probably came out last. After 
the last part goes back, follow it up an inch or more with the 
finger, to make sure that all is in place. Dry the parts, and 
if the tendency to come down is marked put a pad of ab- 
sorbent cotton or gauze against the seat, and retain it with 
a napkin or bandage. This is for the emergency. The cure 
depends upon the cause or attendant conditions, and for it 
a physician's advice is needed. 



X 

HARMFUL HABITS 

THUMB-SUCKING 

In your personal observation, have you ever seen children whose 
teeth projected, or whose upper jaws were V-shaped, because 
of having sucked their thumbs? 

We have often seen the V-shaped jaw in children who were 
thumb-suckers. It is reasonable to suppose that the habit 
was the cause, although it would be impossible to prove that 
the jaw might not have had this shape had the child not 
sucked its thumb, because such shaped jaws belong to some 
families, and no one can recollect whether or not the elders 
were also thumb-suckers. Further, we have seen other and 
more complicated distortions of the upper jaw, and even of 
the nose, probably caused by the pressure of thumb-sucking, 
which it required much trouble on the part of the dentist, 
and expense on the part of the parents, to correct. Those 
who have given most study to the matter (scientific dentists) 
agree in considering thumb-sucking a potent, if not the main, 
cause of the V-shaped jaw. 

OBJECTIONS TO "BABY'S COMFORTER" 

Will you be kind enough to enumerate the reasons why a "baby's 
comforter" should not be used? I have never used the article 
in question, but I really do not know why I should not, for I 
know no argument against it, and while I should not like to 
see it in my baby's mouth constantly, it probably would stop a 
disagreeable noise when she is waiting for her milk to warm. 

302 



HARMFUL HABITS 303 

To enumerate the reasons— that is to say, many of them— 
would be tedious. The function of the medical adviser is 
rather to give his opinion, based on his experience, than to 
detail the experience which formed the opinion. Still, we 
can give you a few of our reasons in short space. We be- 
lieve that the habit of chewing or sucking, except upon food 
to be swallowed, is undesirable, on physiological grounds 
as well as for other reasons. The tobacco and gum habits 
are properly alluded to in this connection, because we think 
that this habit of chewing things other than food is an ex- 
pression of nervousness, and that the ''comforter" habit 
(and thumb-sucking as well) is the direct progenitor of those 
more objectionable habits, through the establishment of the 
desire for something in the mouth. The method of the ex- 
pression of this desire is very various. Witness, for instance, 
the contemporary caricatures of Lord Palmerston, whose 
figure would hardly have been recognized without the straw^ 
in his mouth. Further, unless we are mistaken, this desire 
to suck or chew, when it is not an expression of pure ner- 
vousness, does express some positive discomfort, ordinarily in 
the digestive tract— mouth, pharynx, stomach, or bowels— 
and that it would better be cured than masked. 



HOLDING THE BREATH 

My little daughter, now past fourteen months, has somehow ac- 
quired the habit of holding her breath. This is particularly 
trying, and sometimes looks alarming, when she does it at 
the table, with some food in her mouth. Could you tell me 
what to do in such cases? What is the best way of treating 
this habit, which, I suppose, is the result of temper? Some- 
times a trifling refusal will bring it on, generally at times 
when for some reason she is out of sorts. Should I humor 
her, rather than run the risk of bringing on this distressing 
exhibition, or should she be made to luiderstand every time 
that she cannot have her own way? Is the habit really dan- 
gerous, and, in case of a particularly severe show of temper, 
would a smart slap bring the breath back? 



304 THE CENTURY BOOK FOR MOTHERS 

The holding of the breath in itself is not dangerous, but is a 
trick that some children acquire. Of course, her whims 
should not be humored, assuming her to be in good health. 
She can be made to breathe easily enough by any of the 
manoeuvres that are used to start respiration when it has been 
accidentally stopped (or has not been established, as is often 
the case with a new-born infant), such as the "spank," a 
dash of cold water in the face, or violent blowing in the face. 
Whether it is Avorth while to resort to such measures, which, 
while entirely physiological, have the appearance of a pun- 
ishment, must depend upon individual cases. Most children, 
if they find that the mother cannot be made to yield to their 
desires and cannot be frightened by this holding of the 
breath, promptly abandon the habit, while it is certainly pro- 
longed by indulgence. 

NAIL-BITING AND ITS CURE 

In despair, I write you to learn, if possible, how to prevent our 
boy of ten years from biting his nails. Although a very 
bright boy (of nervous habit), he has his hands almost con- 
stantly in his mouth, which, to our mortification, gives him 
the look of an idiotic child. We have tried gloves, with no 
success ; latterly some one watches him to keep his hands down 
from his face, and the child is constantly hearing, "Hands 
down!" 

If you will suggest a remedy for this disease, weakness of the 
will — which is it? — you will have my warmest thanks. 

The habit of nail-biting is mortifying and to a certain extent 
disfiguring, but it should not be taken too seriously— that is 
to say, it should not be worried over as a real disease. We 
believe that it should, in a general way, be classed with 
habit-spasms, because it is, or was originally, an expression 
of a discomfort, usually nervous, and is continued from habit 
and absent-mindedness. Weakness of will we do not think it 
usually is, unless any neglect of self-control or any indolent 
self-indulgence is to be so called, because we have known some 



HARMFUL HABITS 305 

persons, who carried nail-biting to an extreme, who were 
by no means lacking in will-power if anything awakened it. 

If we are right in this view of the nature of the habit, the 
cure would consist in first doing all practicable to strengthen 
the nervous system and make it comfortable and quiet, and 
then the local preventive measures will take better effect. 

The local measures generally adopted are the use of gloves, 
which you have already tried, and the application to the fin- 
ger-ends of some very strong-tasting substance, the taste of 
which recalls the child from his abstraction, which is the root 
of the habit. The gloves (or bags, which are often used) will 
prevent nail-biting, but not the sucking of the fingers or 
thumbs. The substances used on account of taste are various, 
aloes tincture being the commonest. But we believe that 
general hygienic improvement is quite as important as the 
local measures. 

THE CHEWING-GUM HABIT IN CHILDREN 

Is it true that it benefits children to chew gum, and that it 
helps them to digest their food? I send you inclosed an ex- 
tract from an article in a leading religious paper claiming 
that it is good to promote the flow of saliva by chewing gum, 
and that it prevents children from becoming too hungry be- 
tween meals. 

These discussions as to the harmfulness or benefits of chew- 
ing gum come up in the newspapers from time to time. It 
is usually believed that the chewing of gum is distinctly in- 
jurious by fatiguing the salivary glands ; but now and then 
a dissenting voice is heard urging that the increased flow of 
saliva is useful, both before meals and between meals, in aid- 
ing the progress of digestion. That the flow of saliva is es- 
sential to digestion, and most of all for the digestion of starchy 
foods, every one knows, but, after all, we feel bound to give 
our vote against the chewing-gum habit. If, in chewing, 
the saliva were always swallowed, and if, being swallowed, 
it could be placed just '* where it would do the most good," 

20 



306 THE CENTURY BOOK FOR MOTHERS 

and if, lastly, it were necessary for any one to take starchy 
food unchewed into the stomach, the argument for chewing 
gum or some other similar substance would be strong. But 
for the saliva to do the most good it should be thoroughly 
mixed with the bolus of food in the act of chewing. 

Far better than to chew gum is it to thoroughly chew the 
food itself. If we are right in thinking the chewing-gum 
practice an unwholesome one for adults, it is doubly so for 
young children, who are to a certain extent irresponsible, 
and who easily contract the habit of bolting food and of 
chewing everything else. Our advice would be to prevent as 
far as possible the chewing-gum habit and to encourage pro- 
longed chewing at the table ; and this is especially necessary 
when, as is usual in childhood, the diet is, largely made up 
of cereals. Many of our attempts to render, by cooking, 
food easy of consumption may, through carelessness, result 
in rendering it difficult of digestion. For instance, it is 
very desirable that potatoes should be well chewed; to make 
this easy we mash them ; as a result, they are frequently not 
chewed at all, but bolted. Similarly, we take bread, which 
should be chewed, and which usually must be, to a certain 
degree, before swallowing, and make of it milk-toast, which 
is taken into the stomach almost untouched by the necessary 
saliva. If children come to the table too hungry, give them 
first a drink of milk or a little broth, and keep the food that 
should be chewed until hunger is sufficiently appeased to 
allow them to take solid food. 

LIP-SUCKING 

Is lip-sucking common in young children? Is there any way of 
curing it? 

It is not very common. We have noticed it in those children 
who have a strong tendency to some such habit, and have been 
prevented from its first expression— say, thumb-sucking. 
There is no direct method of cure until the child is old 
enough to be reasoned with. 



XI 
PHASES OF DEVELOPMENT 

THE INFANT'S NORMAL WEIGHT 

How much ought the normal child to gain in one week? What 
is an average or fair weight for a child of four months? 

Growth varies greatly according to age. During the first 
week there is usually a slight loss, which loss is really made 
in the first three days. After this is overcome the gain is 
continual, but not uniform. It varies first of all with differ- 
ent children, depending somewhat, but not entirely, upon 
the original size and strength of the child. A quarter of a 
pound per week is a fair gain for the first month or two, but 
the gain often reaches half a pound weekly for this period. 
By the age of four months it is slackening, being usually 
not much above a quarter of a pound per week. The w^eight 
at that age will be on an average about twelve pounds, some- 
times fourteen or more, but the weight at four months, owing 
to the progressive retardation of growth, is on the average 
more than half what it will be at one year. Thus a child who 
weighs fourteen pounds at four months cannot be expected 
to w^eigh above twenty-five pounds at twelve months, if so 
much ; and the weight at one year will not on the average be 
again doubled before the eighth year is reached. It is usual 
to consider that the birth weight shall be doubled at five 
months and trebled at one year, but this is not true if the 
birth weight is exceptionally large. 

307 



308 THE CENTURY BOOK FOR MOTHERS 

MEASUREMENTS AND WEIGHTS OF BOYS AND 
GIRLS AT VARIOUS AGES 

Will you please give the average height and weight and chest 
measures of a two-year-old, also of a three-year-old child? Is 
there found to be a difference between an average boy and an 
average girl of these ages in regard to size and weight? 

While we have a good many figures regarding the first year, 
and abundance concerning the school age— six years and up- 
ward—we have few regarding the interval from one to six 
years. Dr. Holt has recorded the results of weighing and 
measuring three hundred and seventy-two children from the 
second to the fifth year. These results are as follows : 

Two Years.— Weight: boys, 26.5 pounds; girls, 25.5. 
Height, 32.5 inches for both sexes. Chest, middle of inspi- 
ration, boys, 19 inches; girls, 18.5. 

Three Tears.- Weight: boys, 31.2 pounds; girls, 30. 
Height, 35 inches for both sexes. Chest, boys, 20.1 inches; 
girls, 19.8. Boys keep ahead until about twelve years, then 
fall behind until about fifteen years, when the adult prepon- 
derance of the male begins. 

It is to be borne in mind that for certainty of deduction 
the number of cases must be very large (thousands) ; more- 
over, the race, the social condition, and the locality must be 
noted. As regards our own population, the investigations of 
Bowditch, W. T. Porter, and Boaz are particularly interest- 
ing, bringing out differences according to native or foreign 
parentage, the well-to-do and the poorer classes, and between 
different cities, east and west, and many other details. 



WHEN CHILDREN FIRST BEGIN TO SEE 

Is it true that a baby cannot see anything when it is born, and 
not for days afterward? When does it learn to distinguish 
colors? Do not a child's eyes express very early its pleasure 



PHASES OF DEVELOPMENT 309 

Vision, according to Preyer, is not in the child's power in 
his first weeks. He begins by distinguishing masses of light 
and shade; a small bright spot, when very bright, as a can- 
dle-flame, he can separate, after a few days, from the sur- 
rounding gloom. Of colors he learns first to know red and 
yellow; the blue end of the spectrum gives him much more 
trouble, possibly because blue is more absorbed than the other 
colors by the blood-vessels of the retina. The involuntary 
closing of the lid when an object approaches the eye is wholly 
wanting at first; it is developed by the unpleasant feeling 
of a sudden change in the field of vision (not as a means of 
warding off a recognized danger), and its occurrence in the 
second and third months is a sign of completed power of see- 
ing. Wide-open eyes are a sign of pleasure ; discomfort and 
pain are accompanied by a partial closing of the lids. For 
the first three weeks the child's evident look of pleasure on 
being put into the warm bath is due to the open eyes shining 
from an increased secretion of the tear-glands. 

DEVELOPMENT OF THE SALIVA AND TEAR-GLANDS 

According to several well-known authorities, a baby does not 
secrete saliva before four months. My baby has drooled con- 
stantly since three weeks, and is now two months old; what 
does this signify? 

I also read that it is impossible for a very young baby to shed 
tears. Mine has fairly rained tears since the first week. Is 
this an unhealthy symptom? 

All statements regarding the time at which this or that func- 
tion appears are based upon averages of observations. One 
does not, for instance, expect teeth to appear before the sev- 
enth month, yet a physician of experience will recall in- 
stances of much earlier eruption of the incisors, and may 
even have seen them at birth. There is nothing to be consid- 
ered in the case of your little one except to note that the 
saliva and tear-glands developed earlier than the average. 
This is not a harmful exhibition of precocity. 



310 THE CENTURY BOOK FOR MOTHERS 



THE DEVELOPMENT OF SPEECH 

Why do some children begin to speak so much later than others ? 

Is this necessarily an indication of some physical weakness? 

All my children began to talk late, although otherwise normal 

in their development. 
What do you consider the average age when children ought to 

begin to talk? 

We cannot answer the question in any but a general way. 
The power of speech being a mental gift, it is developed 
very differently both as to degree and time. Fluency of lan- 
guage is no gauge of mental power in general. The most 
eloquent lawyer is not necessarily the ablest one. The pe- 
culiarities of development in time also vary. W^e recall many 
striking instances. Entire families of good mental abilities 
have shown very tardy development of speech. One mem- 
ber (we have in mind an actual instance) was practically 
speechless until about four years of age, when speech began 
suddenly and about as fluent as the average at that age. 
Other members had such broken and lisping forms of speech 
as to be unintelligible to those who were not in daily contact 
with them, but all after a while talked as well as this child. 
Instances might be multiplied of these peculiarities and va- 
garies. We should have no anxiety about a child who was 
not deaf and was apparently intelligent, if speech came late. 
The average age would depend upon what is meant by talk- 
ing. Children say a few words ordinarily well within the 
first year— "Mama," etc. ; after that all the variations above 
described appear, very great contrast being noticed in chil- 
dren of the same age of kindred blood and similar sur- 
roundings. 

IMPERFECT NUTRITION AND ITS CAUSES 

I wish to ask advice about my little boy, who was five years old 
lately. He is of very good height for his age, but thin, his 
ribs and backbone showing plainly. He is quite irritable at 



PHASES OF DEVELOPMENT 311 

times, and is altogether a very nervous child. Lately he wakes 
up in the night and stays awake sometimes an hour. He 
often wets the bed. His digestion and assimilation have al- 
ways been rather poor. 
What can I do for him? Would you recommend cod-liver oil, 
and can you give me some hints in regard to his diet? 

It is quite clear that the child 's nutrition is imperfect, and the 
few symptoms given are expressions of this fact. It would 
be helpful if you knew what causes have led to this condition. 
You will find it profitable to inquire into the heredity. Many 
people never think of this as regards their own families. 
Thus, consider : Is, or was, the thinness and under-nutrition 
a characteristic of the child's ancestors, either in adult life 
or in childhood? Did they outgrow it, etc.? Also, has 
the child's condition been caused or aggravated by known 
illnesses or by errors in feeding, etc.? All these things 
are necessary to a proper understanding of Avhat is to be cor- 
rected. Next is to be considered— and here medical advice 
is useful— the question. Is the child not definitely ill now? 
When these things are known, treatment will be intelligent. 
The diet must be governed by the same things, especially by 
the present condition of the digestive organs. As to cod-liver 
oil, we can only say that it is very generally useful if the 
stomach bears it. 

DROOPING SHOULDERS 

Would you advise me to put braces on my boy of four, who has 
drooping shoulders? 

Unless a child is too feeble to hold himself up, we do not 
think any support advisable. If a child stoops because of 
near-sight, as is sometimes the case, he should have glasses. 
The ordinary kind of stoop in childhood is best cured by 
plenty of active play, not too violent, but enough to develop 
the muscles of the shoulders, back, chest, and, in fact, of the 
whole trunk. 



312 THE CENTUKY BOOK FOR MOTHERS 

LEFT-HANDEDNESS 

Our little girl, aged two years and four months, is inclined to 
be left-handed. At the table she makes use of the left hand 
entirely, and in cutting with a small scissors she uses the 
left hand. What can we do to break her of the habit? I 
have noticed that our baby, aged seven months, also shows 
signs of preferring the left hand for grasping and holding 
things to her mouth. We are a right-handed family, but I 
have wondered if we have not made the children left-handed 
by always offering them things with the right hand. Natu- 
rally, they take them with the left. Is there anything in this 
theory, or do children usually use the left hand first, as they 
first see things "upside down"? 

Left-handedness is not such a misfortune as some people seem 
to think. It is such chiefly in that it makes the left-handed 
person noticeable. It is not an impairment of power or suc- 
cess, except in the use of tools or implements constructed ex- 
pressly for use in the right hand, like the scissors, for in- 
stance. Most left-handed persons can be taught to use the 
right hand for most acts, but when force is required the left 
hand is pretty certain to be called upon. This being the 
case, it is well not to neglect the left hand entirely. Since 
two dexterous hands (two right hands, in other words) are a 
great convenience, our notion is that she should be taught to 
use the right hand for all things where the use of the left 
would excite comment, such as the pen, the knife at table, etc. 
The right-handed habit of the civilized races seems to have 
been in considerable degree acquired. How, no one knows. 
In infancy it is often wanting in those not left-handed, and 
has to be taught. And to our mind it is often taught to a 
foolish and even harmful degree— that is, to such an extent 
that the left hand is nearly useless, except for simple 
grasping. 



XII 
WEANING 

SYSTEMATIC WEANING 

I apply to you for advice in regard to systematically weaning 
my baby. She is now ten months old, well and hearty and 
plump, though having as yet no teeth. She never has been 
fed at all, nothing except water ever being put into her mouth. 
A chicken-bone or a crust of bread she often has to play with, 
but that can hardly be called food. There is still an abundant 
supply at "Nature's fount," but I would prefer to wean her 
as soon as settled cool weather comes. What should she have 
to begin with, and in what quantities? 

Although there are exceptions, a child can usually be suc- 
cessfully weaned with no great difficulty if the mother sim- 
ply persists in her purpose. The infant, of course, does not 
enjoy the change, and the greatest obstacle to the weaning 
is the mother's natural desire to yield to the little one's 
importunities. As a contrast, it is interesting to study the 
skill with which the domestic animals wean their young at 
the proper time. In the weaning the welfare of the child is, 
of course, the prime consideration, but the mother's com- 
fort should not be overlooked. For the latter reason, if the 
supply of milk be still large, the abrupt cessation of nursing 
may be undesirable, owing to the distressing filling of the 
breasts. 

It is assumed that the weather is settled and that the 
child is suffering from no ailment of moment. It will much 
simplify matters if the mother has a trustworthy assistant 

313 



314 THE CENTURY BOOK FOR MOTHERS 

who at first can attend to the feeding, as the child will not 
then be constantly begging for the breast, and, if hungry, 
will probably take the food prepared for it. The mother 
should keep out of sight, and, if possible, out of hearing. 
The food should be given at the usual hours for nursing, and 
the quantity should be as nearly as possible the same as that 
taken from the breast. The amount taken from the breast 
at a nursing is determined by careful weighing of the child 
just before and just after a suckling. The weight gained 
in ounces represents practically the same number of fluid 
ounces of breast milk taken. If the amount is not known, 
the bottle may contain at first about a gill, and if it should 
prove to be not enough more can be prepared for the next 
time. The food should be freshly made each time and given 
at blood-heat. The particular kind of food must depend 
upon circumstances. Where good cow's milk can be had 
it should be the basis of all baby's food. As to what should 
be mixed with it, different persons naturally differ slightly. 
Our own preference (the child being already ten to twelve 
months old) is for barley-water to dilute it and sugar of 
milk to sweeten it. Usually two thirds milk and one third 
barley-water will do to begin with. As the child grows 
older and stronger less dilution is necessary, and the change 
can be gradually made. If the child's digestion is delicate 
the milk may be peptonized wdth benefit, and by some of 
the methods a liquid very closely resembling human milk 
may be obtained. If, however, a healthy child is old enough 
to be weaned, this precaution is rarely necessary. It is of 
course understood that if a child must be weaned early the 
food must differ to suit the age. 

DROPPING THE NIGHT MEAL 

At what age and how can a baby best be weaned nights? If he 
wakes up and wants the bottle, should he be allowed to cry? 

At six months usually, by eight months pretty certainly, a 
child can go from, say, 10 p.m. till early morning, and would 



WEANING 315 

better do so. There is only one way to accomplish this. 
Arrange the day's meals so that the last comes at or about 
10 P.M. Then, if food is cried for, give drink and get the 
child to sleep without feeding. If it will not go to sleep, 
wait till considerably after its usual time before feeding, 
and each night make the hour later until your set time is 
reached. Usually two or three nights at most win the battle. 
Most of the difficulty comes from the bad habit of feeding 
a child whenever it cries, until it comes to feel that it cannot 
become quiet without the breast or bottle, when overfeeding 
may be the real cause of the restlessness. 

NURSING DURING PREGNANCY 

If a mother is nursing her baby and discovers that she is again 
pregnant, ought she to wean the baby immediately, or would it 
do any harm to continue nursing him for some time, if the 
milk does not appear to disagree with him, provided she feeds 
him besides? If the milk does not make the baby sick, would 
it injure the mother or the coming child if she continued nurs- 
ing the baby? If so, in what way? 

It is usually much better to begin the weaning as soon as the 
pregnancy is known, for the milk is very much impaired in 
value, and it is the additional food, not the breast milk, that 
the baby really depends upon for his nourishment. It is not 
to be expected that the milk will ''make the baby sick" in 
the sense of directly ill, although this sometimes occurs ; but 
its results are seen later in his impaired state of health, these 
results being often considered mysterious, although they 
should not be. The effect on the mother and other child may 
not be so evident, perhaps not demonstrable at all as regards 
the child, but the strain upon the mother is unwarrantable, 
and but few women can remain undamaged by it. 



XIII 
SLEEPING 

THE HAMMOCK AS A SLEEP-INDUCER 

Do you consider hammocks injurious to babies? My baby is 
nearly five months old, and for four months I have used a 
hammock for her, getting her to fall asleep in it. It made her 
sick once, when I first got it. With this exception I have never 
been able to discover any bad effects from it; but I have often 
wondered if it could be harmful in any way. 

The hammock, if not violently swung, is no more injurious 
than the cradle or the rocking-chair, presupposing that it is 
a full-sized hammock, which allows the child to lie without 
being doubled up. The whole question whether any kind of 
oscillation is w^orth while as a means of getting a child to 
sleep we cannot enter upon. Such manoeuvres are not neces- 
sary, and, if begun, usually must be continued. The child 
is not benefited, the mother is taxed. Nevertheless, the plea- 
sure of putting one's baby to sleep in the arms often, if not 
always, repays the mother for the tax imposed, at least while 
it is not too heavy. And in view of the generations of our 
cradle-rocked and chair-tilted ancestors we cannot say that 
these rhythmical motions are usually injurious. 

PUTTING A BABY TO SLEEP WITH THE RUBBER NIPPLE; 
"MAGIC" EFFECTS OF SUGAR-RAGS 

How shall I teach my four-weeks-old girl to go to sleep alone by 
herself? A friend of mine accustomed her first baby to go to 

316 



SLEEPING 317 

sleep with a rubber nipple in her mouth, which practice she 
kept up till she was three years old. Does this ever produce 
sore mouth? 
Although "sugar-rags" are an abomination to me, I have been 
guilty of trying them after all other means have failed, and 
when imperative duties demanded my attention. The effect 
has been magical, as, in almost the time it takes to tell it, she 
would be sound asleep. When awake she is as good and quiet 
as I can wish for. 

A four-weeks-old baby ought to sleep two thirds of the time, 
if she is well. Nurse her to sleep, and when her lips slip 
from the nipple lay her down carefully in the crib. Unless 
your nurse has already accustomed her to rocking and "cod- 
dling" on the lap, you should have no trouble in getting her 
to lie still by the hour, sleeping or w^aking. Why give her 
the rubber sham at all, since she will only suck in wind and 
very likely have colic, and will certainly form an absurd 
habit ? 

As to the sugar-rag, the saccharine, farinaceous, and 
greasy foods that make up its contents seriously derange a 
baby's stomach. Colic, wind, and disordered bowels follow 
in the train of the objectionable things. 

EXPERIMENTING WITH ANODYNES 

Will you please tell me what anodyne is best for me to give my 
six-months-old baby ? She is a bad sleeper, and I cannot stand 
being awake so much at night. I have given her chamomilla, 
and once or twice a drop of laudanum. Is there anything 
better than these? 

We advise you to give no anodyne at all nor any sleep-pro- 
ducing medicine, unless it is recommended by a physician 
after a thoughtful consideration of her case. The proper 
thing to do is to seek to the best of your ability, aided by 
your physician if necessary, for the cause of the wakefulness, 
and remove that cause if possible. A cause exists, and can 
usually be found. 



318 THE CENTURY BOOK FOR MOTHERS 



A NIGHT-LIGHT IN THE NURSERY 

What is your advice about burning a dim light in the nursery at 
night? Can it have a bad effect on children's eyes? 

The light will do no harm, especially if it be so shaded as 
not to fall directly upon the child's face. 



THE VALUE OF THE PILLOW IN SLEEPING 

Please inform me if you think it advisable and beneficial to 
have an infant of ten months sleep without a pillow, or the 
head elevated at all. I have always heard that a child becomes 
more straight by lying on its back without the head being 
raised. 

It is really of no great importance, provided the pillow is 
flat and thin. If a child were to lie flat upon the back it 
would be better to have no pillow. If upon the side, as adults 
sleep, a thin pillow would be better. In fact, the infant, 
after it is able to move, lies in a very composite way, and 
practically it seems to us that a slight lift to the head, just 
to save the neck from twisting, is rather the more comfortable. 



THE MOST COMFORTABLE PILLOW 

Please give me some information in reference to the contents 
of a pillow calculated to give the baby the most comfort. I 
use at present one filled with best quality of white horsehair, 
but find that the same has a tendency to fall in. The head 
sinks into the pillow, so as to obstruct the free and easy breath- 
ing, the nose being buried in the pillow. I have heard of 
using "bran" for filling. What do you suggest? 

Hair is the best, but it should be thin and firm, so that it will 
not fall in. A little child's pillow needs to be not more than 
two inches thick at the most. 






SLEEPING 319 



THE FIR-PILLOW 

Will you please inform me whether the fir-balsam pillow is really 
quieting and beneficial to a restless, nervous child? If so, 
where can it be obtained? 

The fir-pillow is an "esthetic" fancy much used as a lounge 
ornament in towns. The odor of the fir-balsam is to many 
persons very grateful. The emanations of evergreen trees 
have been sometimes thought to be beneficial to those suffer- 
ing from pulmonary complaints, but their value, as distin- 
guished from that of the surrounding health-giving circum- 
stances, is not proven. It is possible that a nervous child 
might be pleased with the odor of the pillow, and so quieted, 
but we do not suppose that it has any real medicinal value. 
The ancient pillow of hops is quite as efficient. The mate- 
rials for filling pillows are prepared throughout the fir- 
bearing regions wherever summer visitors go. The cost is 
slight. 

OBJECTIONS TO HAVING CHILDREN SLEEP 
WITH ADULTS 

Is it detrimental to the health of a child three years of age to 
sleep with a grandmother of eighty? And if so, in what way 
is it injurious? 

We think it wiser that children sleep by themselves when 
practicable. There is a prevailing belief that it is not wise 
for the young to sleep with the old, but the reasons given for 
it smack more of superstition than science. The real ground 
of objection, we think, is this : The aged often will not, and 
perhaps from habit cannot, bear the amount of fresh air and 
ventilation that nowadays we think best for children as 
well as adults. In addition, they are apt to overburden 
the bed with wrappings, which does not conduce to the best 
sleep. 



320 THE CENTURY BOOK FOR MOTHERS 

POSITION FOR SLEEP 

What is the best position for a baby to sleep in? 

In our judgment, what is called by physicians the "semi- 
prone" posture is most natural to babies, as to the inferior 
animals— i. e., on the side, but with the back turned a little 
up. In this position a slight turn of the head makes breath- 
ing easy, and the weight of the abdominal organs rather helps 
than hinders respiration. 

SLEEPING ON THE STOMACH 

Is it harmful for a child to sleep on its stomach? 

We have seen many infants and children, and some adults, 
who had the habit of sleeping on the stomach, and have 
never known any harm to come from it. Provided they do 
not bury their faces in the pillows in a way to prevent their 
having sufficient air, we do not know what harm is likely to 
result. It is easy to see why sleeping upon the side is easier 
to most of us than in any other position, but if a child is 
more comfortable lying on the breast and abdomen we should 
let it alone. The observation of habits of the domestic ani- 
mals would reassure you. If you have a house-dog, notice 
how he will sleep upon his side or flat down upon his stomach, 
with his head upon his forepaws. The cat will sleep in any 
position, side, stomach, or back, and all without any damage. 

THE CAUSES OF NIGHT TERROR 

My little boy of five years is greatly troubled with bed-wetting. 
He is taken up at 10 p.m., but he invariably needs changing 
of garments and bed-clothing at least once before morning, and 
very often twice. Our physician, suspecting some irritation, 
performed the operation for phimosis on him last June, from 
which he has been extremely tender ever since, the parts even 
at times approaching rawness on the under side. He also has 



SLEEPING 321 

severe forms of nightmare, screaming out in apparent delirium, 
with eyes wide open, bright, and dilated. His whole form is 
trembling violently, and he presses together his thumbs and 
fore-fingers, as if in the act of picking up. We always take 
him to a lighted room and talk gently, and he always answers 
our questions intelligently in one breath, and in the next 
screams again at his imaginary visions. He generally comes 
out all right in about ten minutes. 
Can you tell me if there is any connection between the irritation 
resulting in bed-wetting and the nervous condition causing the 
nightmare? I forgot to mention we are confident these dis- 
turbances are not caused by anything he has eaten, as they 
occur on going to bed after having no supper. Is he liable 
to outgrow these troubles, or does he need treatment at 
once ? 

The night terror may possibly be due to the sensitiveness of 
the prepuce, but it is more likely not so, for the form of the 
terror is the usual one, and we think that if it were due to 
conscious irritation at that point he would be likely to put 
his hand to the irritated part. In spite of your confidence 
that the terrors are "not caused by anything he has eaten," 
we should urge you to consider his dietary. For it is not 
necessary that the offending substance should have just been 
eaten to cause trouble. It may not be an acute indigestion, 
but a general condition. Thus, some children with very 
good digestions do have too much nitrogenous food— meat, 
eggs, or milk— for their easily excited nervous systems. 

It is, further, wise to prevent or cure the foreskin irritation 
if possible. The best preventives are : making sure that the 
parts are thoroughly dry after each passage of urine, and 
seeing that the tender place is not irritated by any garments. 
Besides, the use of soothing powder or ointments, of which 
bismuth powder or zinc ointment are good examples, will tend 
to heal any existing irritation. It is true that children do 
usually escape from these night terrors as tliey grow older, 
but we would suggest watching carefully for any convulsive 
movements, and, if noticed, consult the physician again. 

21 



322 THE CENTURY BOOK FOR MOTHERS 

WORMS AS POSSIBLE CAUSES OF TALKING IN SLEEP 

I have a little boy, three years of age, who has the habit of talk- 
ing in his sleep. He does not seem to be troubled with night- 
mares, for he very rarely shrieks; but he often talks quite 
loudly, and generally "grinds his teeth." Some months ago 
I mentioned the matter to a physician, who thought it might 
be nervousness, and believed it would soon pass away. One 
of my neighbors thinks his restlessness at night may be caused 
by worms. It is for various reasons not easy for me to send 
for a physician, the nearest being several miles distant. Can 
you suggest a remedy, or at least a cause, for the trouble 
mentioned ? 

Perfect health in children is generally accompanied by per- 
fect sleep. Some kinds of broken sleep are very suggestive of 
certain ailments ; but this is not true of all. The symptoms 
described in the inquiry are not very distinctive. The age 
of the child makes it probable that all irritation from the 
teeth is past. The fact that the sleep-talking is already a 
habit excludes the idea that it is indicative of the approach 
of any acute disease. The cause, then^ is probably some- 
thing chronic or persistent in its nature. Of this sort there 
are a great many, and the exact one can often be discovered 
only by careful inquiry into the details of the child's regi- 
men. A child may be made restless or talkative in sleep by 
any of the causes which produce similar conditions or only 
dreams in adults, and a dream may be very disturbing to a 
child without reaching the terror of a nightmare. Among 
these common causes we may mention difficult or painful di- 
gestion due to errors either as to the kind of food or as to 
the time of its administration, discomfort from an overheated 
sleeping apartment or too much covering, or the reverse con- 
ditions. Any form of mental excitement during the day, and 
especially during the latter part of the day, has a similar 
effect. There are a multitude of other little details that need 
to be looked to before the cause can be positively ascertained. 
As to the importance of worms as a cause of the symptoms 



SLEEPING 323 

described and of many others, popular belief is far more 
closely in agreement than the opinions of medical men. 
AYithoiit pretending to settle a vexed question, we may give 
what we think a fair statement of the matter. The frequency 
of worms varies greatly in different localities ; and apparently 
there is a similar difference in the severity of the affections 
caused by their presence. The particular worms most com- 
mon in children are the ''thread" or "pin" worm, and the 
larger lumbricoid or "round-worm." The local irritation 
from the former is very evident, and it often prevents, as 
well as disturbs, sleep ; but remoter and general disturbances 
are rarely attributed to this kind of Avorm. Its presence can 
usually be determined by careful ocular inspection. It is the 
"round- worm" that plays such a great part in popular 
pathology. Now, while it is doubtless a fact that the pres- 
ence of this worm in the intestine does often cause general 
disturbance, it is certain that it does so far less frequently 
than is commonly supposed. It is very often present with- 
out any particular disturbance of health being noticed; and 
it may be said that, of all the so-called symptoms of worms, 
there is not one that may not be due to some other cause. 
Even when ocular inspection has established the presence of 
the worms, it may be that they are not the cause of the symp- 
toms attributed to them, and treatment beyond the removal 
of the parasites may be necessary. This symptom of dis- 
turbed sleep, with "grinding of the teeth," is probably one 
of the most constant with children suffering from lumbri- 
coids, but it may also be constant in any chronic disturbance 
of the bowels ; and a physician may really consider the pres- 
ence of the worms only a coincidence or a complication of the 
bowel troubles, while the nurse is sure that it is at the root 
of the whole matter. It is therefore inadvisable to give a 
child "worm-lozenges" or the like without the distinct opin- 
ion of a physician, who can also advise as to the treatment 
of coexisting troubles which may persist even if the worms 
be discharged. 



xiy 

BATHING 

A BATH AT NIGHT 

When a child about three years old, able to play out of doors in 
the grass all day in the summer, comes in at night — of course, 
very dusty — is it advisable to give the daily bath then, or 
would a slight sponge-bath at night, in addition to the morn- 
ing bath, be too much? 

The chief difficulty about giving the bath at evening is this : 
The child comes in tired and hungry as well as dusty, and 
wishes to eat and then probably to sleep. The bath cannot 
be given immediately after eating, and to keep him hungry 
until after the bath may precipitate a domestic storm. For 
these reasons (not for physiological ones) we think the light 
sponge-bath will be found less fatiguing to the child and to 
its mother than the other plan, and, all things considered, 
probably better. 



THE EFFECTS OF COLD AND WARM BATHS 

Can you tell me in what cases cold baths are beneficial to chil- 
dren? Are they strengthening to a delicate child? Is a warm 
bath weakening? 

The constitutional effects of baths vary with the temper- 
ature. Cold, as is well known, if it does not exceed the 
resisting power of the person, is a tonic, producing in- 
creasing tissue changes, and consequently increased nutri- 
tion. The cold bath shares this strengthening power. But 

324 



BATHING 325 

if the cold is too great or too long in its application the ex- 
hilarating "reaction" does not take place fully or at all; 
the result is fatigue, exhaustion, or even severe prostration. 
The cold bath, moreover, has curative value under some cir- 
cumstances because of its shock to the system. The shower- 
bath, the douche, and a varietj^ of baths in which a current 
of water is used are exaggerations of the cold bath, inasmuch 
as the cold and the shock are combined ; and the same is true 
of the sea-bath. The cold bath, in all its varieties, is chiefly 
used as a tonic, and extensively employed for children who 
are feeble. It seems unnecessary to insist that, as the bath 
is intended to strengthen the little patient, it should under 
no circumstances be used in such a way as to depress. As- 
suming this, we may mention some of the conditions under 
which it is likely to prove beneficial. Children who have a 
sluggish circulation, with poor appetite and feeble digestion, 
are often markedly benefited by systematic cold bathing. So 
also are children who are constantly ''taking cold" and chil- 
dren suffering from rickets. Furthermore, in some kinds of 
nervous ailments, such as St. Vitus 's dance (chorea), as also 
the peculiar crowing croup seen most frequently in rickety 
children, cold bathing is useful, but in these instances it 
should not be used without medical sanction. 

The warm bath is not stimulating, but relaxing. It pro- 
duces a fulness and increased color of the skin, due to the 
greater amount of blood brought to it. A warm bath is at 
first agreeable, but, if prolonged, enervating. The hot bath 
produces like results, but in a higher degree ; and if the tem- 
perature be near 110° it can be borne but a short time with- 
out causing excited action of the heart and other disagreeable 
symptoms. These, in a few words, are the principal effects 
of hot and cold baths, and from them their remedial uses 
may be inferred. 

SOAP 

Is the use of soap necessary or desirable in daily baths? For 
children's use which is preferable, a good Castile soap, or some 
of the numerous "scented" or other "fancy" varieties? 



I 



326 THE CENTURY BOOK FOR MOTHERS 

Soap is necessary only at places where especial need of clean- 
liness exists— face, neck, armpits, seat, and groins. But as 
the moderate use of bland soap is not harmful to most skins, 
it is easier to go over quickly the whole or most of baby's 
body than to pick out spots for washing. 

' ' Castile, " if of good quality, is excellent. There are other 
excellent soaps made. But avoid scents. Your object is to 
clean the baby, and to know if it is sweet when you have 
finished you must avoid artificial smells. A clean baby is 
sweeter than any perfume. 



DIMINISHING THE FREQUENCY OF BATHS 

When shall baby's daily bath be discontinued? Never, I hear 
some say; but suppose the mother's time and strength are very 
much taxed? 

If a change is to be made, how many baths should be given 
a week, and are they to be given night or morning? 

You answer this question yourself. It is to be continued 
as long as you can give it. It is given in the main for clean- 
liness, and is no more necessary at six months than at six 
years. The immersion is not a necessary part of the bath. 
A quick sponging does as well. 

As many as you can give. If you can give only three 
baths a week, or two, or even one, give them. They are pref- 
erable in the morning, as a cool sponging is a protection 
against taking cold, and the exposure is more likely to occur 
by day than by night. 

THE OUTING AFTER A BATH 

How long after a bath should a baby be kept indoors? My baby 
is nine months old; she usually sleeps till eight or later. I 
give her a bath at once, letting her sit two or three minutes 
in water at 90°. Lately, after wrapping her in her blanket, 
I have sponged her in water at 50° before drying and rubbing. 
She enjoys it all and is warm afterwards. 



BATHING 327 

Last winter I sometimes took her out in an hour. If she slept 
till nine, and I went out in the forenoon, I could not wait 
longer. But I feared it was hardly safe, though she has never 
taken cold in consequence, and, indeed, has never had a severe 
cold. When a little baby she wakened at 5 a.m., had her bath 
at eight, and was fed afterwards. But she would never take 
a long nap after her bath, often none at all. 

We believe that after a bath at 90° the child could as safely 
go out in an hour as at any time— supposing it fit weather 
to go out at all. If she is sponged in water at 50°, we believe 
that she could go out as soon as dressed, with the same pre- 
sumption as to weather. 



XV 

TEETHING 

IS NORMAL TEETHING PAINLESS? 

I would like to ask if the teething of healthy children is with- 
out pain or discomfort? I am no believer in the theory that 
every derangement of the system during dentition is attribu- 
table to that as a cause, but after an experience with three 
strong, healthy babies of my own I cannot readily accept the 
theory that — as one physician expressed it — "dentition is as 
painless a process as the growing of the finger-nails." 

My little six-year-old, just cutting the "seven-year molars," 
complains frequently of soreness and discomfort of the gums. 
Is it irrational to believe that a younger child, with less vigor 
for endurance, suffers equal discomfort in cutting the first 
teeth, and that, using the only means of expression at his 
command, he becomes fretful and peevish, gradually develop- 
ing more or less f everishness in consequence of the discomfort ? 

My youngest child, whose dentition has been very slow, cut her 
third incisor when she was fourteen months old. For weeks the 
tooth had seemed so near the surface that I expected every day 
to feel its edge. Then the gum became inflamed, the covering 
skin was hard and tightly drawn, the child fretful. On the 
fourth or fifth day I discovered a small gathering of pus at 
one corner of the uncut tooth. I sent for my physician, who 
lanced the gum, freeing the tooth and giving immediate relief 
to the child. Is such an experience unusual, and what is the 
probable cause of the pus? The child has no tendency to 
humor of any kind, and at the time was in her usual health. 
Could such a case be attributed to derangement of stomach or 
bowels, or was I right in considering it an incident of den- 
tition ? 

328 



TEETHmG 329 

Let us put it in another way. Not ''that the teething of 
healthy children is without pain and discomfort," but that 
pain and discomfort— if unusually great— are at least pre- 
sumptive evidence that the process of the evolution of teeth is 
not going on in a normal or healthy way. This change is 
not a quibble, but a different point of view. For, first, the 
phrase "a perfectly healthy child" has no meaning unless 
that judgment has been passed by a competent authority. 
AVe recall scores of children so described to us who Avere, 
to our mind, anything but healthy. Further, in practice we 
have, not so very rarely either, been asked to admire as evi- 
dence of unusual health or strength Avhat we considered 
marks of disease. Apparently what is generally meant by 
the phrase "perfectly healthy" is that the person described 
does not come, or at least comes rarely, under medical care. 
In adult life persons who attend without complaint to their 
daily avocation are considered "perfectly healthy," although 
one may have chronic constipation, another frequent head- 
aches or oft-repeated neuralgic affections, while another may 
have all the obscurer manifestations of gout, but escape the 
typical swollen toe, and so on to the end of the chapter. 

Now, the change of view regarding teething Avhich has 
come to the great majority of physicians who especially study 
children's diseases is not that they do not think that the 
baby suffers or that they do not sympathize with its suf- 
ferings, but that they no longer think that this suffering is 
natural or normal. If the child suffers much from denti- 
tion, even locally, they think that the child is not entirely 
well, or the reaction of a physiological process would not be 
so severe. Very often indeed one skilled in children's ail- 
ments can point out where the deviation from health is 
which probably underlies the troublesome dentition. We do 
not say that it "is as painless a process as the growing of 
the finger-nails," but many experts at least will be inclined 
to say that in health it ought to be. There is no manner of 
doubt that children's gums are often painful at dentition— 
we do not here discuss the remoter ailments often charged 



330 



THE CENTURY BOOK FOR MOTHERS 



to dentition— but it is doubtful if the pain ought to be of 
such a nature as to disturb sleep or to cause any great dis- 
comfort. Take a case from your own letter. Your little 
one cuts its third incisor at the age of fourteen months, a 
delay so great as to be of itself sufficient cause for looking 
the child over carefully for a disordered condition of nutri- 
tion to account for it. Then an abscess forms in the gum. 
This shows very unusual irritation, and, according to our 
present belief, pus cannot form unless the necessary micro- 
organism has been introduced, in this case probably from 
without. The occurrence was "an incident" (or rather acci- 
dent) "of dentition." It was probably not due to any tem- 
porary derangement of stomach and bowels, but rather pri- 
marily to that peculiarity of system which delayed dentition, 
and, as we said before, to the introduction of one or other 
of the pus-exciting organisms into the tissue, most likely from 
without through handling the gum or the chewing upon some 
substance, as teething children often do. 

The change in view, we have said, leads not to any doubt 
of the baby's suffering, but to giving greater attention to his 
condition— to the condition before and during teething, with 
the view of preventing pain and illness. 

If the question is asked : What does it matter to us in the 
nursery whether the many disorders attending teething are 
caused by it or not? we answer just this: If the parents be- 
lieve that dentition causes all the ailments attributed to it, 
they are, as we daily see, prone to consider the ailments as 
nearly, if not quite, as much a matter of course as the natu- 
ral teething process, and they consider it useless to try to 
cure them until teething is complete. Moreover, by a sort 
of inverse reasoning, if any of the disorders which they are 
accustomed to regard as dependent upon dentition happen 
to exist, they infer that the child is teething, whether he 
be so or not. As a result of all these errors and confusions, 
it too frequently happens that disorders which might have 
been very tractable at the outset are allowed to progress un- 
opposed until they reach a serious stage. If, on the con- 



TEETHING 331 

trary, we assume that teething is rarely the real cause of 
disease, the parent will seek some other reason for any dis- 
turbance of the system that may exist, and will endeavor to 
remove it, either with or without the aid of a physician. The 
difference of opinion is then not a simple dispute of terms, 
but one which has a practical interest in the nursery. 



LATE TEETHING 

I cannot think that my baby had any tendency to rickets, as 
he was exceptionally strong and robust, but when a year old 
he had only two teeth, and did not get the stomach and eye 
teeth until two years and a half old. He seems to have good 
teeth, and I had somewhere imbibed the idea that late teeth- 
ing made good teeth, as I knew of four children who got no 
teeth until about a year old, all of whom had beautiful teeth 
in after years. Do you consider late teething as unhealthful ? 

Some normal differences exist as to the time of teething— the 
medical books set seven months as an average for the first 
tooth to show, but many children begin two or three months 
earlier, and some later. Late teething is, by common agree- 
ment of all who have studied the subject, one of the signs of 
rickets, and it is a sign easily noticed by the mother, while 
she might overlook others. Rickets in its less marked forms 
is one of the commonest disorders of early childhood, and one 
which seems to be habitually overlooked unless it has ad- 
vanced to the degree of producing deformities. 

Late teething is never an advantage. A child's teeth may 
be delayed by rickets, and, after his recovery, come through 
in good enough shape, and the second set of teeth may es- 
cape damage altogether. The late examples you speak of 
were probably, to .judge from the usual course of such cases, 
children who were kept on breast milk which was really not 
up to the mark, and only after weaning did they get mate- 
rial with which to push their teeth, or, if bottle-babies, they 
had at length become accustomed to their food. 



332 



THE CENTURY BOOK FOR MOTHERS 



On the other hand, late teething alone— i. e., unaccom- 
panied by any other evident derangement of health— cannot 
be accounted a disease. It is frequently a family peculiarity. 

DROOLING 

Can anything be done to stop a child's "drooling"? My boy, 
now nearly two years old, has drooled constantly since two 
months old. He had no teeth until he was seven months old, 
and now has sixteen. He got the bottle until a year old. He 
is not unnaturally thirsty, but likes something wet in his 
mouth, and never loses an opportunity to take a wet cloth or 
sponge. I have spoken about it to two good physicians, but 
they seem to regard it lightly, and tell me I may be thankful 
nothing of importance is the matter with him. Let me say 
that the child is as forward in everything as others of his age. 
Are such cases of drooling not very unusual? 



We may say first, to relieve your anxiety, that the ailment 
in all probability ''is nothing more serious than an annoy- 
ance." Quite evidently something has overstimulated the 
salivary glands, and the child's desire to take wet things 
into his mouth suggests that he is conscious of an irritation 
of the gums. Very probably the remaining teeth of the tem- 
porary set are in process of eruption, and when this is over 
the irritation will cease. Another possible cause is this: If 
there is any obstruction to free breathing through the nostrils, 
the opening of the mouth may stimulate the flow of saliva. 
At all events, such cases of constant drooling are not rare. 



XVI 
THE TEETH 

STRENGTHENING THE TEETH 

What food is best for strengthening the teeth? 

If there is no evident disease of the teeth, the best way to 
insure continued soundness is not to give any one thing 
supposed to be strengthening to the teeth, but a good, whole- 
some diet, and, above all, to avoid the use of those things 
known to damage the teeth. The articles of food most likely 
to injure teeth are probably those the digestion of which, 
either generally or in the particular instance of the person 
concerned, are found to promote acidity of the stomach. Of 
course careful attention to the toilet of the mouth is assumed, 
and the care of a dentist whenever his services may be needed. 
Actual disease of the teeth can rarely be controlled without 
his attention. We may add a Avord concerning the teeth of 
young children. It is of advantage to keep an infant's teeth 
clean in the same way as an adult's teeth are so kept. If 
teeth are already decayed they should be carefully attended 
to, and the decay hindered by cleanliness after each meal. 
If teeth are defective in structure, with, for instance, thin 
or irregularly absent ('Svorm-eaten") enamel, it is doubtful 
if anything can be done to strengthen these particular teeth, 
but coming teeth may be helped by care of the general health, 
and, as many believe, by the use of the lime salts, particu- 
larly the phosphate. The hypophosphite, generally found in 
the drug-shops in the form of a syrup, seems to be of some 

333 



334 THE CENTUEY BOOK FOR MOTHERS 

use. The same may be said of the syrup of the lacto-phos- 
phate of lime, and some judicious practitioners still esteem 
the powder of phosphate of lime, and even the powder of 
ground bone. 

EFFECT OF EARLY FEEDING UPON THE TEETH; 
THE USE OF THE TOOTH-BRUSH 

I have heard as coming from a physician that feeding a baby 
very early, before the nursing period was ended, had a ten- 
dency to injure the material of the coming teeth. What can 
you tell me about it? 

Should a child's first teeth, as soon as they are well matured, be 
brushed with a tooth-brush or simply washed as the mouth has 
been washed before? 

Any improper feeding before or after the discontinuance of 
nursing, or even nursing when the milk is impoverished, may 
lead to rickets and to imperfect teeth as a result. The ques- 
tion is as to the kind of food, rather than the mere fact of 
feeding. 

The tooth-brush will not harm the teeth directly, but it 
may, especially if stiff, injure the gums and secondarily the 
teeth. Little children, and especially babies, do not usually 
like to have their teeth brushed, and struggle against the 
performance. It is, therefore, difficult to apply the brush as 
accurately as could be desired. Consequently, to avoid the in- 
jury to the gums spoken of, we think the washing preferable. 

EARLY DECAY OF TEETH 

My baby boy, seventeen months old, has fourteen teeth. The 
first ones already show signs of decay. What is the cause of 
this, and can it be arrested ? If so, how ? 

By all odds the commonest cause is faulty nutrition, which 
may exist whether the child is nursed or fed. If the defects 
are localized, your dentist can do much to preserve the teeth 



THE TEETH 335 

by careful attention. If the decay is general, involving the 
whole surface of the teeth, he can do less or little. But he 
should by all means be consulted and allowed to judge 
whether or not the case is one which he can benefit. The ex- 
pense will be well repaid by the improvement in the child's 
freedom from toothache and in the better condition of the 
coming set. 

DISCOLORATION OF THE TEETH 

My baby is two years and a quarter old. He has been very 
slow cutting his teeth, the last ones (his stomach teeth) hav- 
ing come through two weeks ago. About two mouths ago I 
noticed his four front upper teeth were turning dark; the dis- 
coloring now covers more than half the upper part of them. 
He has always, though very good about everything else, fought 
against taking a drink of water and having his mouth washed, 
consequently it has been very imperfectly done. Could that 
cause the trouble, or does it come from acidity of the stomach, 
from which he suffered greatly the first year? 

If the discoloration is only a superficial one— that is, simply 
the greenish stain often seen on the teeth— it is probably due 
to the neglect of cleansing. The fact that the discoloration 
is on the upper half of the teeth makes this more likely. But 
we ought to say that the same physical peculiarity that favors 
late teething also is attended with stomachic disorders and 
discoloration and early decay of the teeth ; so this is a matter 
to be looked into. The damage to the teeth does not come 
immediately from the acidity of the stomach, but they are 
associated manifestations of one cause. 

PECULIARITY OF TEETH 

My baby, nearly two years old, is perfectly well. Her little 
tongue is as red and smooth as possible, but she has several 
small spots, depressions, somewhat discolored, on the face of 
the front upper two teeth. This peculiarity exists in her 
father's family, the front teeth of several of the members 



336 THE CENTURY BOOK FOR MOTHERS 

being short, strong, and healthy, but not perfectly white, and 
having these discolored depressions, about the size of a small 
pin-head. Can anything be done to prevent the second set 
from appearing the same way? She has had eighteen teeth 
for six or eight months past. 

This peculiarity of the teeth is well known. We recall fami- 
lies where it is found in parents and children, having existed 
from childhood in the parent. Now, whether the peculiarity 
is a hereditary one in the strict sense, or whether some nutri- 
tional peculiarity that has caused it in tAVO generations is the 
heredity, or whether it is simply due to some traditional (and 
in one sense hereditary) method of feeding we cannot deter- 
mine. We incline to the second supposition. The fact of 
their existence in the primary teeth does not determine their 
reappearance in the second set. We know of nothing except 
general good hygiene that is useful. Keep the child as well 
as possible, and wait. 

REMOVING REDUNDANT OR "EXTRA'' TEETH 

My little daughter, twenty-three months old, has a redundant 
incisor tooth which came through three months ago, forcing 
its way painfully between the two upper incisors on the left 
side of her face. The back one of these incisors pierced the 
gum a little higher up and farther back than the correspond- 
ing tooth on the right side, thus leaving a space between the 
left incisors about half the width of a tooth. The redundant 
incisor cut through this space obliquely, with the edge of the 
tooth directed to the left and outward instead of downward. 
It is disfiguring, and will, I fear, crowd the other teeth, and 
I do not wish it to appear in the permanent set. Will you 
kindly advise me how soon it should be extracted, also if the 
operation will be attended with any danger? I have feared 
the effects of an anesthetic on so young a child, especially as 
she is of a very nervous organization. 

Such a tooth is usually removed by dentists as soon as it 
crowds the others, or when they think the proper order of 



THE TEETH 337 

the teeth is deranged by its presence. Whether or not a 
supernumerary tooth will appear in the permanent set does 
not depend upon the extraction of the present tooth, but 
upon the existence or absence of the rudiment of that per- 
manent tooth in the jaw. A dentist of ordinary skill can 
extract the tooth safely, and will ad^dse you if he needs ad- 
ditional aid in giving the anesthetic, if indeed that is neces- 
sary. The simple extraction of an incisor might cause less 
disturbance than the administration of an anesthetic. If a 
supernumerary tooth appears in the second set the dentist 
can also advise concerning its removal. 



THE FILLING OF THE FIRST TEETH 

Should the first teeth of children be treated just like teeth of 
adults? That is to say, should a cavity be filled and the tooth 
preserved as long as possible, even if, in the natural order of 
things, it could stay only a year or two longer? 

The details of treatment should, of course, be left to the judg- 
ment of the dentist, but the general rule, we believe, is to 
continue as far as possible the usefulness of the tooth until 
it is replaced by its successor. Painful filling can hardly be 
done to the teeth of little folk, but something in the Avay of 
soft filling and the like can be done. This, we think, not 
only prevents toothache, but enables the child to chew prop- 
erly, and also gives the second set a better chance of per- 
fection. 



UNUSUAL ABSENCE OF UPPER INCISORS 

Have you ever heard of a child failing to cut the upper lateral 
incisors? My little boy, now nearly two years old, has cut all 
of his teeth except these, which should have been cut a year 
ago, and the second molars; and I feel very much afraid that 
the disfiguring little spaces upon each side of the two front 
teeth will not be filled up. 
22 



338 THE CENTURY BOOK FOR MOTHERS 

Yes. Deficiency in the number of teeth, as well as redun- 
dance, occurs. Sometimes there is a symmetrical absence of 
teeth in the first set, while the second set is complete, and 
sometimes the reverse happens ; or both sets may be imperfect 
or redundant. 



XVII 
THE EYES 

SQUINT 

My little boy, two and a half years of age, has from infancy had 
the bad habit of looking over his head, owing, no doubt, to a 
slight cast in his eyes. About three months ago I noticed that 
he turned the left eye in very slightly, and lately it has be- 
come much worse. The other eye is slightly affected, too. 
Our family physician says the eyes may become all right later 
on, and that, any way, an operation will relieve the trouble; 
but I don't want to think of such a necessity, as the child has 
lovely, bright eyes, and I fear they may be injured through 
the operation. Do you think an operation is necessary in 
such a case? Is it a very complicated one and frequently 
done? 

Though it is possible that occasionally the squint may be reme- 
died by means short of an operation, yet in most cases the 
latter procedure becomes necessary. Sometimes, though 
rarely, the use of proper glasses, which correct the defect of 
vision, if applied early enough, may cure the squint. The 
operation usually resorted to is not a very formidable one. 
If the child is old enough not to be frightened at the 
sight of instruments, cocaine may be used to abolish pain, 
and thus the use of ether be obviated. However, in most 
children the production of unconsciousness by a general anes- 
thetic, such as ether or chloroform, is necessary. The opera- 
tion consists in severing the muscle the over-action of which 
causes the squint, or in severing that muscle which, through 

339 



340 THE CENTURY BOOK FOR MOTHERS 

the weakness of its opponent, causes deformity. Sometimes 
the operation is done upon one side, sometimes it is neces- 
sary to perform it upon both eyes. The severed muscles then 
attach themselves, or are attached, further back upon the 
eyeball, and thus, having diminished leverage, are weaker 
than they were before, and accordingly allow the eyes to 
assume the straight position. The healing after the opera- 
tion is rapid. 

It is scarcely necessary to dwell upon the change in the 
appearance of the child after the operation has produced the 
straightened condition of the eyes. It is very marked, and 
sometimes wonderful. So far from your having reason to 
dread an injurious effect on the eyes, the operation can only 
improve them. The operation for squint is probably the 
most frequent of all the operations upon the eye attempted by 
the oculist ; it is also one of the most certain in the results in 
skilled hands, and hence no excuse exists for allowing a child 
to go about with the great disfigurement which the existence 
of squint entails. 

TEST FOR CROSS-EYES 

There seems to be some defect in the eyes of my boy of five, but 
I cannot exactly call it a squint. Sometimes he looks decid- 
edly cross-eyed for a minute or so, while most of the time his 
eyes are quite normal. What is the usual test for detecting 

cross-eyes ? 

The test most commonly employed by oculists to detect 
*' cross-eyes " or ''squint" is to cover one eye, and have the 
child look with the other at the examiner's finger, held at a 
distance of about fifteen inches directly in front of the child 
in the median line; if this be done, and the hand covering 
the eye be slightly tilted so that the examiner can watch the 
covered eye, the latter will be seen to roll, or move inward 
or outward, according to the nature of the squint. Then, by 
suddenly removing the hand from the eye previously cov- 
ered, the difference in the direction of the axes of the two 



THE EYES 341 

eyes will be very apparent; the observation must be made 
quickly, however, since the squinting eye will soon correct 
its position so that its axis will correspond to that of the 
other eye, and both will then become fixed upon the exam- 
iner's finger. This test should be applied first upon the eye 
which appears to squint, and then upon the other in a like 
manner. 

It must be remembered that cross-eye, at the commencement 
of the trouble, is often present only at certain periods and 
absent at others. Also, that it is frequently due to errors 
of vision which may be corrected by the fitting of proper 
glasses. 



NEEDLESS ANXIETY ABOUT BRILLIANT EYES 

Is there any necessity for worry because a baby has bright eyes? 
This seems like a very silly question, but I suffered with a 
complication of nervous troubles before my baby was born, 
and have been especially sensitive about him. And now an 
officious friend has ''stirred me up"; on first seeing my beau- 
tiful, healthy boy, he exclaimed, "What wonderfully bright 
eyes he has! Has he ever had anything the matter with his 
head? No? I thought he might have had, as they are so 
very bright!" Under the circumstances I did not like it, to 
say the very least. 

There is no necessity for worry whatever. Nor, as far as you 
have given the facts, is there any ground for anxiety. If 
you have reason to suppose your baby hereditarily excitable, 
try to avoid excitements for him. Brilliancy of the eye is 
not an evidence of disease by itself. 



EYE-PUPILS OF DIFFERENT SIZES 

How serious a trouble is a difference in size of the pupils of the 
eyes, or how serious may it become? What may be done to 
correct it or its cause? My boy is six months old, and the 
difference in his pupils is very marked at times. When the 



342 THE CENTURY BOOK FOR MOTHERS 

pupils are small I observe no difference, and for a time have 
thought the direction or amount of light had the effect named, 
but now I am convinced the pupils are at fault. 

The difference may or may not be a symptom of importance. 
Associated with other disturbances it often betokens serious 
brain troubles. On the other hand, cases are met with where 
the discrepancy has existed from birth and has continued 
many years in a person of good health, who is unconscious of 
any disturbance of vision. 

STIES 

Our little girl of fourteen months has had twelve sties or little 
boils on her eyelids. They commenced to come about six months 
ago, a little before I weaned her and just after the first teeth 
had come through; she now has eight teeth. During the last 
few months she has grown thin, but of late seems to be "pick- 
ing up" again. All but two of the sties came on the tips of 
her lids, both upper and lower, and they have caused her to 
lose nearly all of her eyelashes. The last two sties seemed 
more serious than the others. One was almost on the side of 
her nose, and was opened four times, twice by myself and 
twice as she hit it with her hand, each time discharging much 
matter. I have consulted three physicians, but they have not 
helped her. Can you tell me the cause? How can I help her? 

The ordinary causes are local inflammatory irritation, acting 
upon a system deranged in some way, especially when the 
patient suffers from anemia (thinness of blood), or is of 
scrofulous habit. 

The general condition must be looked to. The diet 
should be examined to ascertain if it be well digested. Iron 
may be needed, or perhaps cod-liver oil. Locally the prompt 
opening of sties as they occur is very useful, as well as the 
careful cleansing of the lids. Some of the products of the 
inflammation may not be discharged as pus, and later on may 
excite further irritation or remain as an indolent mass in the 
lids. These are the general principles of treatment. Al- 



THE EYES 343 

though you have consulted three physicians, we still think 
that you will do better to try again than to attempt domestic 
treatment. Pick out one physician, and continue with him 
long enough to find out what he can do and to give him some 
interest in his little patient. 

CLIPPING THE EYELASHES 

Is it true that clipping the ends of the eyelashes is beneficial, 
and is it likely to cause them to grow longer? When is the 
proper time to do it? 

Clipping the eyelashes cannot be beneficial in any way, but 
may be decidedly harmful. The lash is the protector of the 
eye. Cutting, if it affected them at all, would be likely to 
make them coarse. There is no proper time to do it. 

A "WEEPING" EYE 

My little boy of four months has an eye that "weeps" — that is 
to say, it is almost always full of water, which runs down his 
cheek and seems to irritate the skin. What is the cause of 
this? Should it be treated? 

The description seems to correspond to an obstruction of the 
tear-duct. This can be determined only by a physician. If 
such an obstruction exists a skilful surgeon can remove it, 
and thereby relieve the trouble. 

EYE-STRAIN AS A CAUSE OF HEADACHE 

How can one recognize headache due to eye-strain? 

Only by a careful examination by a competent oculist can it 
be determined. But it may be suspected whenever the head- 
ache is associated with or follows the use of the eyes, espe- 
cially on any kind of near work. It is always to be consid- 
ered when any one suffers from persistent or frequent 
headaches. 



344 THE CENTURY BOOK FOR MOTHERS 



PINK-EYE 

How can one tell pink-eye from an ordinary cold in the eye? 
Is pink-eye contagious? 

Both terms being popular rather than scientific, it is not easy 
to make a scientific distinction. ''Cold in the eye" we sup- 
pose to mean a conjunctivitis (inflammation of the covering 
of the ''white of eye") which is associated with a "cold," 
and which may be the main manifestation. As "colds" 
usually are due to some infection, it is probable that these 
"colds in the eye" are due to local infection— ordinarily, we 
believe, to dust or dirt which was infected. "Pink-eye" is 
really a term of veterinary medicine, meaning a contagious 
disease of horses in which the inflamed eye is a prominent 
symptom. Of recent years the name has been applied, jo- 
cosely at first, to a similarly prevalent and doubtless conta- 
gious disorder in human beings. There is no real distinc- 
tion as we understand the matter, unless it be the difference 
of the kind of infection. If the disease is prevalent it is 
popularly called "pink-eye." If it does not spread it is a 
"cold in the eye." 

GRANULAR EYELIDS 

How do granular eyelids differ from ordinarily inflamed eye- 
lids? What is the treatment? 

The distinction is not easy to put into popular language. 
An "ordinarily inflamed eyelid" probably means a catarrhal 
conjunctivitis, which usually yields readily to skilful treat- 
ment (the purulent conjunctivitis is not now meant) . Gran- 
ular conjunctivitis is essentially a tedious and slow-moving 
disease. It gets its name from a change in the tissues, chiefly 
inside the lower eyelid, which gives to the surface a granular 
appearance. Its treatment is not domestic. Usually pro- 
longed medical attention to the eye is necessary. 



THE EYES 345 

ASTIGMATISM 

How can one recognize that a child is astigmatic, and what can 
be done for the defect? 

The defect called astigmatism in an eye or in a lens is a 
want of perfect symmetry in its different meridians, so that 
the rays passing into the eye or lens are not refracted to pre- 
cisely the same point. Its location and degree are deter- 
mined by optical apparatus. It may be suspected, at least, 
by the. parent if the child sees differently in different meri- 
dians. Thus, if a child sitting at a distance, say across a 
room, from a clock sees some of the figures clearly and others 
not, one or both of its eyes are probably astigmatic. Then 
let the child go nearer to the clock, and observe if the same 
numbers are clearly seen as before. 

The relief is the adjustment of glasses specially ground so 
that they correct the defect of the eye. 



XYIII 
THE EARS 

EARACHE 

Can you give any suggestions as to remedies for earache in chil- 
dren? My little boy of five suffers from it very much, and it 
always comes on at night. I use sweet-oil and laudanum, 
warm, dropped in the ear, or soak a piece of cotton and put it 
in the ear; to this I sometimes have to add a hot poultice of 
hops, and all this will frequently give no relief for a long time. 
There does not seem to be any especial cause for these attacks, 
as our physician has examined him several times. 

The occurrence of pain in the ear is a pretty positive sign 
that this organ is not in perfect condition, or that some 
part in the immediate neighborhood is diseased ; thus, besides 
disease of the ear itself, such pain may be due to the impac- 
tion of wax in the ear canal, or to throat or nose trouble. 
Hence removal of the cause of the pain by the physician 
would naturally be most advisable. To relieve the attacks of 
earache, when the cause is unknown, the instillation of hot 
salt water will be found most efficient. The salt water should 
be prepared by dissolving a teaspoonful of table salt in one 
pint of water. This should be used as hot as can be borne 
by the sufferer, and should be poured into the canal of the 
ear by a teaspoon and then allowed to run out again by in- 
clining the head ; this may be continued for half an hour or 
an hour until the pain ceases ; or the hot salt water may be al- 
lowed to flow into the ear from a fountain syringe held not 

346 



THE EARS 347 

higher than one foot above the level of the ear. After the 
application of heat in this way, a large piece of cotton wad- 
ding should be placed over the ear and covered by a layer 
of oiled silk. 

PARTIAL DEAFNESS 

I wish to get advice in regard to my little boy's partial deafness. 
Before he was three years old a severe cold would make him 
hard of hearing, and now, at five years of age, the same trou- 
ble exists, and the deafness continues long after all signs of 
cold have disappeared. He has recently had a bad cold and 
earache, and he has remained hard of hearing so long that we 
are anxious lest his trouble should become permanent and 
past relief. He has never had much earache or any discharge 
from his ear. Is there danger of its becoming permanent 
deafness? Can we do anything to prevent this? He has al- 
ways been a delicate child, having little endurance. His colds 
always take a croupy turn, and but for constant doctoring 
would terminate in spasmodic croup. 

There is always danger of permanent deafness under such 
circumstances. Catarrhal troubles are probably the com- 
monest cause of deafness, and they are very active in just 
such delicate children. The child should certainly be taken 
to a physician, who, by advice as to his general regimen and 
by local treatment of his throat and nose, may be able to 
prevent the advance of deafness. 

PROMINENT EARS 

My little boy is nine months old, and his ears seem to stand out 
more and more all the time. When he was younger he was a 
frail child, and I did not dare to do anything about it ; but now 
that he is rugged can I not correct this feature by tying them 
back in some way? He has otherwise a handsome face. 

It is probable that persistent bandaging might press the ears 
flat; such treatment is successful in arresting the growth of 
the feet in certain classes of women in China. But we are 



348 THE CENTURY BOOK FOR MOTHERS 

entirely certain that we would not allow any such thing to 
be done to any child that was under our care. The object 
to be gained is of trivial importance compared with the per- 
sistent discomfort— running over months or years— that must 
be inflicted upon the child. When an ear projects as the 
result of an inflammation the case is different, as slight pres- 
sure for not a very long while at a time tends to replace the 
ear in its normal position. AVe might add, however, that 
inasmuch as the projecting ears give much distress to you, it 
might be proper to try one of the caps of tapes sold in the 
shops for producing pressure on the ears. They do not so 
closely cover the head as an ordinary cap, and are less objec- 
tionable. But even with these we think that evidences of 
discomfort should be watched for. It is . best to use the 
tape cap only at night, or when the child is by itself. It 
annoys the child to be made noticeable, and the treatment 
itself may make him painfully conscious of his ears. 

TAMPERING WITH LARGE EARS 

"Little pitchers have big ears." Unfortunately for my dear 
little girl of seven years, hers are large, physically and meta- 
phorically. They stand out like handles. This peculiarity is 
not hereditary, and I am anxious to correct it. Can you help 
me with your advice? When I tie ribbons over them to press 
gently she complains of soreness in a short while. Am I in 
danger of doing an injury to the internal organ by pressing 
externally? I am anxious to free her from the misfortune of 
prominent ears in later life. 

AVe can help you with advice, and it is to let the ears alone. 
Any pressure you make is far more likely to irritate the 
ears and thereby increase their want of beauty than to im- 
prove their appearance. The ear, for some reason or other, 
seems to be considered a part of the body that can be trifled 
with. Very few persons would think of meddling with a 
nose that was not shapely, or Avith lips that were ill-looking, 
but the ear is practised upon in various ways. It is hard to 



THE EAES 349 

say why the wearing of rings in the ears should have sur- 
vived the kindred mutilation of the nose and lips. Time 
may improve the set of the ears, and, at all events, the ar- 
rangement of the hair will improve their appearance far 
more than anything you can do to them. 

HARDENING OF EAR-WAX 

What causes wax to harden in the ear, and what is the remedy? 
My little girl, aged three and one half years, is bothered with 
wax in both ears. 

There are several known causes. The chief are over-forma- 
tion of the ear-wax and a changed composition of it, due 
usually to inflammations of the ear. The only preventive 
we know of is to keep the ear and throat in a healthy condi- 
tion. The removal of an accumulation is accomplished by 
mechanical means. Probably, for domestic practice, the saf- 
est way is to soften the mass by keeping a little sweet-oil in 
the ear for a day or two, and then gently syringing out the 
ear with lukewarm w^ater. 



CAUSE AND PREVENTION OF EAR TROUBLE 

My little girl of five years has had two gatherings in her ears, 
both of which I treated, according to the physician's instruc- 
tions, by gentle syringing of warm water with boracic acid 
dissolved in it. 

Is there any way to prevent these attacks, except by precau- 
tions against taking cold? Is there danger of loss of hearing, 
and, if so, can it in any way be prevented? 

These attacks nearly always come from the spread of an in- 
flammatory process (probably bacterial) from the throat. 
Whatever measures, hygienic or medicinal, prevent throat 
trouble prevent also ear inflammations. 

There is danger of deafness if, as we assume, the trouble 
is in the middle ear. The treatment of middle-ear trouble 



350 THE CENTURY BOOK FOR MOTHERS 

must lie with the physician. Puncture of the ear-drum is 
often necessary, and is of great value in limiting the mis- 
chief threatening. 

SIGNIFICANCE OF A RUNNING EAR 
Is a running ear always a sign of some chronic trouble? 

No, for the running may be only recent and occurring for 
the first time. But a frequent or a recurring running of the 
ear is presumptive evidence of a chronic trouble. 



XIX 
THE HAIR AND SCALP 

STRENGTHENING THIN HAIR 

I have reason to believe that my little girl, now three and a half 
months old, has inherited a weak growth of hair. Can I do 
anything now, or a little later, to strengthen the hair and 
roots ? 

It is too soon to be anxious about the child's gro\vth of hair. 
She may never have an abundant growth, but its present 
thinness is no evidence to that effect. The greatest variabil- 
ity exists in regard to the time when the hair becomes thick. 
We have seen children at birth whose hair was so abundant 
as to need a regular toilet, and who at three months of age 
looked as if they were wearing wigs. On the other hand, we 
know adults whose hair is very thick who were practically 
bald up to two years of age. 

Nevertheless, as you are anxious, we may give you some 
hints as to what to do and what not to do. If the hair had 
fallen out from an illness or from a disease of the scalp, some 
medication would be advisable; but in such a case as you 
describe it certainly is not. What you have to do is to give 
the scalp the best possible chance to grow the hair. See that 
the scalp is always clean— that is, free from dandruff, from 
the flaky deposit often met with (seborrha?a). See also that 
the head is not heated nor unnecessarily covered. But in 
giving it this attention do not irritate it. Do not rub it 
roughly nor use much soap upon it. Wash it gently, dry it 
gently. Remove any deposit upon it by very gentle friction 

351 



352 THE CENTURY BOOK FOR MOTHERS 

with a finger anointed with vaseline or any perfectly bland 
oil. Use a very soft brush in arranging the hair and avoid 
combs altogether. Adhere to the same gentle precautions 
after the child is older, and you will have done, in our judg- 
ment, the best that can be done. 

WASHING THE SCALP 

When a child's scalp seems perfectly healthy and there is a good 
crop of hair, how frequently should the entire head be washed 
to insure a continuance of health? Also, with a predisposi- 
tion to catarrh of the head, is there danger in washing, if the 
hair is thoroughly rubbed till it feels dry? 

Wash the head often enough to secure cleanliness of the scalp, 
which may be determined by frequent careful examination 
for dandruff, etc. Instances occur where the ''catching 
cold" seems to be directly dependent on the washing of the 
head ; but as a rule it is safe to wash the head, if the washing 
is done in a warm room and the hair is thoroughly dried 
directly afterward. 

THE USE OF SOAP ON THE HEAD 

My three-months-old baby's head is always white and clean, and 
I have washed it with soap every morning, using a little vase- 
line once a week. I notice that for a few days after using 
the vaseline the scalp is just as clear as his little face, and 
then the skin begins to look dry. Does the use of soap tend 
to dry the natural oil of the hair? 

For some weeks after birth the ''lathering" has a good effect 
in dislodging the secretion of the scalp, which is then often 
excessive. After a while it is not necessary to use soap every 
day in the head-washing, two or three times a week usually 
being enough ; but if any scurf begins to form the daily use 
of soap can be resumed. First, however, try if vaseline will 
not remove the scurf, as it is less irritating than some soaps. 



THE HAIR AND SCALP 353 



TAMPERING WITH THE COLOR OF THE HAIR 

I should be greatly obliged if I could get information as to how 
to make a baby's hair gradually darker. My little boy's eye- 
lashes being very light, I fear his hair will remain about the 



We have no advice to offer except that you should carefully 
abstain from all attempts to change the natural color of your 
child's hair. No attempts on your part will effect anything 
but damage to the hair. There is a very strong tendency for 
children's hair to darken after two or three years of age. 
Most mothers would rejoice in the blonde hair of a baby. 



MILK-CRUST 

Does milk-crust differ from eczema, and what can be done for it ? 

Milk-crust is a name applied to the eczema of the scalp and 
face of young children. Its treatment is rather too difficult 
for domestic practice. The essentials of the treatment are the 
regulating of the nutrition of the child (if artificially fed, 
usually its dietary needs supervision) ; the soaking off of the 
crusts and keeping the scalp clean ; and the application of 
soothing remedies, usually in the form of ointments. 

THE BELIEF THAT LONG HAIR IS WEAKENING 

My little girl is just four years old, and has an unusually long 
and heavy head of hair for her age. She is not a very strong 
child, and several friends have advised me to cut her hair 
off, but I dislike the idea very much, as her hair curls in 
loose ringlets, and it is a great ornament to her. When it is 
dampened a little and brushed out straight it reaches almost 
to her waist. If I thought her strength was going to her hair 
I would not sacrifice her health, but nothing else would induce 
me to cut it. Will you tell me if you think I should cut it 
off, or would cutting it partly be of any benefit? 
23 



354 THE CENTURY BOOK FOR MOTHERS 

She does not complain of headache, but suffers somewhat from 
stomach disorder, as her tongue is often quite white, especially 
in the morning. 

The belief that long hair is weakening is very common, but 
we know of no real ground for it. So far as we have been 
able to discover, it may, like any excessive growth of body, 
be weakening if proper nutrition is not kept up, just as we 
hear the expression, ''The child has outgrown its strength." 
In such cases the indication is not to try to stop the grow1:h, 
but to spare the child taxing occupations, and see to its nu- 
trition, until the balance is restored. If the growth of hair 
were really in any case excessive, we should deal with it on 
that plan. But to cut it off will not help. It does not retard 
growth. It is thought to stimulate it, rather. There are rea- 
sons why we sometimes recommend cutting long hair. Thus : 
Suppose a child has reached an age of great activity, and is 
ahvays romping, climbing, etc. ; a long wad of hair on the back 
of the neck acts as a muffler, making the neck perspire ; the 
next moment it is blown aside or falls aside in the child's 
activity, and the neck is chilled. AVe do believe that, under 
these conditions, especially in an active boy, the alternate 
heating and chilling of the neck and ears does tend to aggra- 
vate or cause catarrhal conditions of the nose, throat, and 
ears. Your own child seems to need judicious care of her 
stomach from a physician, rather than the barber's atten- 
tions. 



XX 

THE FEET 

INCIPIENT CORNS 

I have always been very careful about my little girl's shoes, that 
they should neither pinch nor rub, and she wore moccasins 
for a long time. She is now three years of age, and on the 
little toe of each foot there is a decided corn, the size of a 
pin-head. Is there any way in which I can cure them, so that 
she need not be troubled with them always? 

There must be some mistake. Corns never come unless there 
is pressure or friction, and nothing can permanently cure a 
corn so long as the pressure or friction continues. A shoe 
may be very large and yet produce corns because its shape 
is not right. We have seen many moccasins of such faulty 
shape that they could not fail to produce irritation. 

First of all, reconsider the question of shoeing. See if the 
shoe holds neatly to the ankle and hinder part of the foot; 
see next that there is plenty of room for the toes not only to 
go in but to expand and play as the foot is moved. Often it 
is requisite to get shoes two or three sizes too long in order to 
secure the necessary width. In the fitting of the shoe lies the 
whole matter. 

The relief of an already acquired corn may be accom- 
plished best by first paring, then applying to the surface a 
solution of salicylic acid, say one part to eight of water, and 
after a day or tw^o scraping away any part that has been 

355 



356 THE CENTURY BOOK FOR MOTHERS 

softened by the application, and repeating this until the corn 
is removed. 

The corn, too, may be protected from friction by means 
of a plaster with a hole of suitable size in it, the plaster being 
so applied that the hole falls immediately over the corn. 
For children's feet these plasters are best made extempo- 
raneously from several layers of the ordinary adhesive plas- 
ter to be found at drug-stores. 

DISTORTED FEET 

What is the remedy as well as prevention for misshapen feet? 

Why, if the baby foot is shaped rightly (the toes slightly spread, 
and the weight apparently evenly divided over the sole of the 
foot and on the bottom of each toe), when shoes have been 
worn for a few years, does the shape of the foot change and 
the ends of the toes turn downward, the joints pointing up- 
ward? This is the way the feet of my oldest boy, aged six, 
and my girl, aged three, have changed, although they have al- 
ways worn shoes at least one fourth of an inch longer than 
their feet. I cannot but feel that the trouble is in the width. 

Is it lack of sufficient length or width that is to blame for the 
immense joint, that sometimes inflames, on the inside of the 
foot? 

The remedy lies chiefly in the wearing of the same kind of 
shoes that would have prevented the distortion in the first 
instance. But after a certain degree of displacement and 
rigidity has occurred other management is necessary. The 
subject is too wide to be treated of in the space at our com- 
mand. 

We are not sure that we understand correctly what is in- 
tended. There is a crumpling up of the toes and the thrust- 
ing of one under another, due to the shoes being short or 
too narrow and pointed ; this change is a familiar one. But 
we think you mean a change which is natural and proper, 
within limits— namely, that the habit of springing upon the 
toes in walking gives to them, particularly the outer ones, a 



THE FEET 357 

slight curve upward, with some enlargement of the bulbous 
extremity. You can reexamine the children's feet and see 
which change you have to deal with. If the toes are crowded 
together and the imprint of one is left upon another, the 
shoes have done at least a part of the distorting. 

Insufficient length may have some share in distorting the 
joint. But the deformity is created thus : A shoe, the inner 
margin of the sole of which turns outward — as is usual in 
shop-shoes — at the toe- joint, crow^ds the great toe toward its 
fellows; pressure is made upon parts of the joint not well 
prepared for it, then the narrow upper chafes and sets up an 
inflammatory process, which ultimately results in chronic 
thickening of the soft parts, and even of the bone. These 
distortions sometimes are so extreme as to render the cutting 
out of the joint necessary. 

INGROWING NAILS 

Can you tell me of some cure for ingrowing toe-nails, and also 
what is liable to cause them? It cannot be tight shoes in the 
case of my two-year-old, as I have always been especially care- 
ful to have his shoes roomy and comfortable. He seems to 
suffer from them, and I feel anxious to help him by some sim- 
ple means, if possible. 

The mischief done by shoes is less from small size than from 
faulty shape. It is, of course, possible that an ingrowing 
nail may not come from tight shoes, but certainly ninety- 
nine cases in a hundred are due to the shoe pressing the toes 
together. The great toe most frequently suffers ; it is crowded 
against its neighbor, the flesh is pushed up and laps over the 
nail, and the margin of the nail, being crowded toward the 
center of the toe, turns downward and so grows. Sometimes, 
however, there is no fault in the nail itself, simply in the 
crowding up of the flesh, which thus becomes irritated under 
the pressure. If a foot has never been crowded, the sides of 
the toes are rounded as at birth, and, like the fingers, remain 
so through life. Actually, it is rare to see a foot some of the 



358 THE CENTURY BOOK FOR MOTHERS 

toes of which have not left their imprint upon their fellows 
from this lateral pressure. Keep the toe that is in trouble 
separated from its neighbor by a folded piece of linen put 
between them— slightly oiled if there is sign of friction 
against the linen— and the trouble will probably be relieved. 
If necessary, the down-growing corners of the nails may be 
raised by the thrusting under of a pledget of soft cotton. 
In paring the nails do not cut off the corners, but cut the 
nail square across. These corners should protect the flesh; 
if cut off the tendency to burrow is increased. 



XXI 
HYGIENE AND SANITATION 



THE OBJECTIONS TO VACCINATION; SUPPOSED FAILURE 

OF VACCINATION TO PROTECT; THE PROPER 

AGE FOR VACCINATION 

There have recently occurred in our community several cases of 
small-pox, and the health board has ordered that all school- 
children be vaccinated, and advises parents of even younger 
children than those of school age to have them revaccinated. 
This seems to many of us a very unnecessary and harsh mea- 
sure, as not a few intelligent persons here and elsewhere are 
quite skeptical about the value of vaccination, particularly in 
the case of very young children. Is it not true that children 
have often been inoculated with scrofula, consumption, and 
other diseases through the vaccine virus? And how is it that 
vaccination so often does not "take"? Is not a child of less 
than two months too young to be vaccinated? 

This letter again calls attention to the singular prejudice 
against vaccination still surviving among otherwise vv^ell-in- 
formed persons. It is difficult to account for this on any 
other theory than that the almost complete immunity from 
small-pox which the civilized world of to-day enjoys has 
caused it to forget what were the ravages of that plague a 
hundred years ago. The objections to vaccination have been 
often urged, and again and again met. An apparent failure 
of vaccination to protect is invariably due to neglect of sec- 
ondary operations; and as to the often expressed dread of 
the introduction of scrofula and consumption into the system 
through vaccination, there is practically no evidence whatever 

359 



360 THE CENTURY BOOK FOR MOTHERS 

in support of the assumption, when proper virus was used. Of 
course, the virus must be properly chosen and applied by a 
physician, for in unskilful hands it certainly may work mis- 
chief. Good virus well applied is practically always safe. 
The mischiefs attributed to vaccination are almost always 
due to something else. Generally speaking, a child is never 
too young to be vaccinated if there be danger of an exposure 
to small-pox, and it is better that the operation be performed 
before the teething period begins. When the child is six weeks 
old it is time to consider the question seriously, and the 
vaccination should not be delayed unless the physician sees 
reason for postponing it. 



THE DISADVANTAGE OF POSTPONING VACCINATION 

My husband and I both have a horror of vaccination, and, liv- 
ing in the country, have never had it performed. If it is to 
be done, will it be the worse the longer we put it off, and what 
time of year is best for the operation? Our baby is fourteen 
months old. 

The disadvantage of postponing vaccination (aside from the 
special risk of infection taken, which is diminished just in 
proportion as your neighbors live up to their duty in this 
matter) is chiefly this: The older the child the more active 
it is, and the more likely to injure and irritate the point of 
vaccination and to infect it with some other matter (from 
finger-nails or elsewhere), and so change a perfectly harm- 
less affair into a possibly serious one. As to your ' ' horror, ' ' 
we can say nothing, as sentiments cannot be argued about. 
But we can say in all seriousness that the arguments against 
doing things on Friday because it is unlucky are much more 
convincing than the arguments urged against vaccination. 
To our mind, neglect of vaccination, unless a child have some 
illness or other disability, is distinctly wrong. There is no 
particular time which is preferable to have it done, but as 
the skin is more likely to be irritated in very hot and very 



HYGIENE AND SANITATION 361 

eold weather, we should perhaps elect the milder seasons ; but 
the time to have it done is when your physician has good 
fresh virus on hand. 

Whether for the reasons given above or some other, it is a 
fact that young babies are less disturbed by vaccination than 
older ones. 



THE DESIRABILITY OF KEEPING WATER ON THE STOVE 

I would like to ask your opinion as to the desirability of keeping 
a vessel of water on the nursery stove. Formerly I thought it 
was the proper thing to do, to keep the air moist. Then I 
was told that the steam was considered objectionable, induc- 
ing throat troubles. Which theory is correct? 

It is hard to prove anything as regards the effect of a vessel 
of water or its absence, but our own notion, which Ave offer 
for what it is worth, is this : A vessel on a stove hot enough 
to generate steam is not desirable except as a remedy under 
certain circumstances, as, for instance, in croup. But if a 
room is heated in such a way as to make its air too dry, a 
broad vessel of water standing in the room may give off 
enough vapor to mitigate this dryness. The vessel may be 
near the stove, but should not be so placed as to generate a 
visible steam. 

PLANTS IN THE BEDROOM 

I wish to ask your advice about having plants in a bedroom. I 
am so situated that my bedroom must also be my nursery, 
and I should like to make it as attractive as possible. A bow- 
window affords plenty of sunshine from seven o'clock a.m. 
until five o'clock p.m. Is it unhealthy to have plants growing 
in a bedroom? 

Plants are not usually injurious in a room during the day- 
time. When there is sunlight the plants absorb carbonic acid 
and appropriate its carbon and set free a certain amount of 



362 THE CENTURY BOOK FOR MOTHERS 

oxygen. This process is not harmful, but rather the reverse, 
to animal life. The only harm that need be considered is 
that possibly arising from any considerable quantity of damp 
earth in the room, but this is probably very slight. But with 
the coming of darkness this process of absorption of carbonic 
acid ceases, and a certain amount of the gas is given off ; just 
how much, of course, varies with the quantity and kind of 
plants in your greenery. The effect is in kind, if not in 
degree, very much the same as that of having another person 
sleeping in the room. If you can arrange your plants upon 
a stand with casters that can be rolled out of the room before 
sundown and brought back in the morning, the plants will 
probably be harmless; otherwise they are better away. 

PROPER AND IMPROPER FILTERS 

Will you please tell me what kind of a filter is best to use for 
filtering water? I have read so much both for and against 
filters that I had come to the conclusion that there was about 
as much danger in using the ordinary filter as in giving the 
water unfiltered, but after reading an article on "Intestinal 
Worms" I would like to have your opinion on the subject. 

If you care to buy one of the well-known "Pasteur" filters, 
which are rather costly, or a similar one, and Avill keep it in 
order, you will have, we think, a safe article. Ordinary fil- 
ters, we believe, do more harm than good. They strain out 
coarse dirt, but they are admirable culture places for all the 
micro-organisms found in water. Our favorite device for 
cleansing water is to have a number of bags made of stout 
flannel Avith strings at their mouths. One of these is tied 
over the opening of the faucet and the Avater turned on gen- 
tly; this strains out coarse (visible) dirt. No bag should be 
used longer than one day, and if the Avater is unusually 
dirty the bags may be changed several times daily. They 
should be thoroughly boiled before being used again. If 
there is any reason to suppose that the A\^ater is uuAvhole- 
some, it should be boiled before using. It may be kept in 



HYGIENE AND SANITATION 363 

stoppered bottles or jugs, and if desired for drinking a bottle 
may be easily cooled in the refrigerator. 



SULPHUR FOR DISINFECTION 

We have had one mild case of scarlet fever in our family, and 
our doctor has depended for disinfectants entirely upon fresh 
air, sunshine, and an open fire. The patient has been isolated 
in a bare-floored room for four weeks and will be longer, the 
other children being in perfect health to-day. As to fumiga- 
tion by sulphur, the doctor says that the "Sulphur Congress" 
has just decided that the fumes of sulphur have no effect on 
disease germs. If this is so, why is not this fact proclaimed? 
Is it because, as our doctor says, "It is better for some people 
to keep their faith in sulphur, as they cannot be induced to 
open the windows unless there is a very strong odor to dis- 
pose of"? 

We are well aware that sulphur fumigations, if poorly car- 
ried out, and perhaps as usually done, are useless. But while 
the debate as to the value of sulphur fumes has gone on, we 
have not been convinced that, if properly used, they are 
useless. They must be used with moisture, hence we usually 
make steam at the same time with the vapor ; and they must 
be made to penetrate every portion of the apartment to be 
disinfected. It is easy to admit that more powerful disin- 
fectants exist, but the use of most of them is generally not 
practicable. At the present time formaline lamps of moder- 
ate cost and considerable efficiency are sold in drug-shops and 
similar places. These are efficient. It may be also admitted 
that one living in a country village may rely more upon air 
and sunshine than a city dweller, because the former gets 
more of these natural purifiers, and because he endangers 
fewer persons by this method of disinfection than would 
the latter. In this particular disease, moreover, the fact 
that many escape contagion under all circumstances is 
helpful to the success of whatever plan of disinfection be 
adopted. 



364 THE CENTURY BOOK FOR MOTHERS 



DISINFECTANTS 

Will you tell us of an article or articles to use as antiseptics 
and deodorants for a cesspool whose funnel-shaped opening is 
near the house? Dish-water and such slops only are emptied 
into it, and it discharges into a rapidly flowing creek about 
thirty feet distant. 

One of the cheapest articles is sulphate of iron (copperas), 
which may be thrown into the cesspool if it contains standing 
liquid ; if not, dissolve the copperas in a pail of water. Com- 
mon rock-salt used abundantly is useful, and more powerful 
than either is a mixture of salt and sulphate of zinc— say 
three parts of the former to four of the latter— dissolved in 
water and poured into the cesspool. 



GROUND AIR FROM EXCAVATIONS ; QUININE AS A 
PREVENTIVE OF FEVER AND AGUE 

A serious defect in our drain renders it necessary for us to lay 
new pipes outside the house. This of course means the turn- 
ing up of impure earth. Will you suggest some safeguard for 
children who, while playing outside, are somewhat near the 
trench? The work may take a week or more. Would you 
advise quinine to be given during that time? 

Chlorinated lime in powder, or a copperas solution, sprinkled 
over the earth is probably as good as anything. If in a dis- 
trict where fever and ague often appears, the quinine may 
be given in moderate doses. 



TEMPERATURE OF THE NURSERY AND THE BEDROOM 

What is the proper temperature of the night and day nurseries? 

Day nursery, 65° to 68°, or, at most, 70° F. Some strong 
children can get on at a lower temperature than 60°, but the 
figures set are the best average. The night temperature may 



HYGIENE AND SANITATION 365 

be cooler, but not very much, as the child is liable to toss 
its bed-clothes off. 



THE GAS-STOVE IN THE NURSERY 

My nursery is over the kitchen, but cannot be heated from it. 
There is no room above. We rent the house. I put in last 
autumn a small stove to be open or shut, and burn either wood 
or coal, but it sent out so much gas and smoke that, it being a 
warm season, we seldom used it. The afternoons are not cold 
enough to require a fire in the room, but I must have some 
way of heating it before the baby comes from her bedroom in 
the morning. The chief difficulty with the present stove is 
that the hole into the chimney is rather low, and the draft is 
not good, especially when the kitchen stove is first lighted. 

Could I use a gas-stove, or anything else that would not require 
connection with that bad chimney ? Please tell me what would 
be the best and, incidentally, the least expensive method of 
heating this room. 

A gas-stove of the ordinary kind is always very objection- 
able, because the products of combustion are left in the room, 
and the air is more vitiated by one, even if small, than it 
would be by the presence of many persons. If you can find 
any form of good gas-heater Avith an escape-flue for fumes it 
might do. The chimney certainly ought to have a separate 
flue for each room. Your nursery stove, in a properly con- 
structed chimney, ought to draw all the better if the kitchen 
fire has already warmed the chimney. If you cannot find a 
stove that will draw properly, we think the best plan would 
be to carry the pipe of the kitchen stove through the ceiling 
and into the chimney in the nursery. In a mild climate 
sufficient heat would probably be given off from the heated 
stovepipe for the needs of the nursery. 

HOW LONG DO DIPHTHERIA GERMS LINGER? 

I have been considerably troubled about my duty toward an ac- 
quaintance who recently moved into a house near mine, where, 



366 THE CENTURY BOOK FOR MOTHERS 

five months ago, there were two bad cases of diphtheria. The 
children were desperately ill, and one of them, as I heard the 
physician himself say, was saved by antitoxin only at the last 
moment. 
I believe the house was thoroughly disinfected, but, nevertheless, 
it was quite a shock to me when I learned that the lady I 
speak of had moved into the house with her two sweet little 
children. I try to put myself in her place, and know that I 
should have been so grateful if some conscientious neighbor 
had warned me of the possible danger, even if the landlord had 
not thought it his duty to do so. To speak of it now that she 
has moved into the house may create unnecessary alarm, and 
yet, perhaps, it is my duty, after all, to let her know the facts. 
In any case, as a similar dilemma may arise elsewhere, I shall 
be glad of your opinion as to whether diphtheria germs may 
remain active in a house five months after the outbreak of the 
disease, and how rigorous a disinfection will secure absolute 
immunity from diphtheria, at least as far as the original cause 
of the outbreak is concerned. 

We cannot answer the question in a way to help you decide 
your present duty, although we know that the Klebs-Loeffler 
bacillus remains a long time in the throats of those Avho have 
had diphtheria, without known reinfection, and that it is 
found in the throats of persons apparently well, and who, 
so far as any one knows, have not had diphtheria ; and while 
we know that the poison may, under favorable circumstances, 
cling for a very long time to articles which have been about 
a patient, yet there are so many doubtful points about the 
''virulence" of these persisting bacilli, so many possibilities 
of reinfection, that it is impossible to know the truth with 
exactness. But given a house which had been ''thoroughly 
disinfected," and which had for a while stood untenanted, 
we should think that it was very probably as safe as most 
houses. And in this case whatever harm is likely to follow 
is already done. Nevertheless, we do feel that the owner of 
the house ought in fairness to tell the renter of the circum- 
stances. 



HYGIENE AND SANITATION 367 

DANGER OF TYPHOID FEVER TO BABIES FROM IMPURE 
DRINKING-WATER 

Are young babies ever exposed to the danger of contracting 
tiy-phoid fever from impure drinking-water? 

The young baby, perhaps, is least exposed to danger from 
impure drinking-water because it uses little of it. If it is on 
the breast it drinks little but breast milk; if it is artificially 
fed, the milk and the water it uses are commonly raised to or 
near to the boiling-point in the course of preparation. This 
fact, probably, is one of the reasons why typhoid fever is so 
much less common in children under one year than in later 
childhood. 

SUSCEPTIBILITY TO SECOND ATTACKS OF DISEASE 

I have been told that a baby having a contagious disease while 
nursing will be liable to take it again. My little girl had the 
measles when ten months old. Do you think she would take 
it again if exposed? 

There is no such rule. Children under six months are not 
very susceptible to measles or scarlet fever, and those under 
four months have very nearly an immunity from the latter 
disease. But a great many children have these diseases in 
the second half of the first year. It is true, also, that a good 
many persons have them, especially scarlatina, more than 
once. All any one would be justified in saying is this: If 
a child has measles under six months of age it is likely- 
other things being equal— that it is unusually susceptible. 
Such a child is, of course, more liable to second infection than 
another. In your child's case there is no ground for unusual 
anxiety. 

PHYSICAL EXERCISE FOR GIRLS 

What physical exercises are best adapted for girls as distin- 
guished from boys? More particularly, ought girls from live 



368 THE CENTURY BOOK FOR MOTHERS 

to seven years of age to walk, run, and jump as much as boys 
of the same age? 

Girls from five to seven years of age may practically have 
the same exercises as boys of the same age, with, perhaps, only 
a little reserve as to heavy exercise (in proportion to age), 
because even at this early age the boy usually shows some- 
thing of the superior muscular strength that is so marked 
in adult life. But they may walk, run, and jump like boys 
if they are not unusually excitable girls. 



DISINFECTING PAPER MONEY FROM A SICK-ROOM 

Is there any way of disinfecting paper money kept in a room 
where there was a patient seriously ill with diphtheria? 

You can disinfect paper money without damaging it by either 
of two easy methods : Pour a little alcohol on a piece of sul- 
phur and burn them on a brick or flat stone, laying the bill 
near them, and covering all with an inverted stone jar so as 
to secure the fumes ; or soak the bill in a two-per-cent. solu- 
tion of carbolic acid and water. If one has a formaline lamp 
its fumes are best of all. 



BABY POWDER 

What kind of starch or chalk do you consider innocuous when 
used as baby powder for the customary purposes of drying 
the skin? 

Buy the best starch and pound it into powder, sifting it 
through coarse Swiss muslin or cheese-cloth. Perfume it 
with orris-root, and you have a harmless ''baby powder." 
Avoid the chalk as a toilet article. It has some value in cer- 
tain conditions of irritated skin, but should not be used 
habitually. 



HYGIENE AND SANITATION 369 

THE VALUE OF WATER IN RHEUMATISM 

Please give me your opinion of the value of distilled water for 
children who have evidently inherited a tendency to rheuma- 
tism. Will its continued use eradicate the rheumatic poison 
from the blood? Would a child given distilled water suffer 
from the lack of the salts contained in natural water? Is 
distilled water hurtful in any way? The child is four years 
old, and has had occasional rheumatic pains, but the general 
health is fairly good. She has subsisted mainly on cow's 
milk, and never had an acute attack of rheumatism. 

We believe that water, distilled or otherwise, is very bene- 
ficial for those who have the rheumatic peculiarity. We do 
not know that distilled water is any better than a pure, fairly 
soft drinking-water. We do not, however, think the distilled 
water hurtful. But we do not suppose that water will re- 
move the tendency, which is usually an inheritance, while it 
will help to relieve attacks or even chronic pains. 

THE TREATMENT OF NERVOUS CHILDREN 

My youngest child, nearly a year old, seems to inherit from his 
parents the nervousness which, to a greater or less extent, all 
our children — six in number — manifest. I confess I am dis- 
couraged, for, in spite of my most earnest endeavors to keep 
baby quiet, he is restless, especially at night. In most essen- 
tial respects he is well — in fact, he is pronounced by many 
mothers of my acquaintance an unusually fine and well-devel- 
oped child. His food appears to agree with him, and he has 
been quite a lively toddler since he was ten months old. Still, 
I am troubled by his tossings and his evidently vivid dreams 
at night; and, if possible, would like to save him from at 
least the graver form of nervousness (St. Vitus's dance) which 
has overtaken one of his older brothers. 

Do you think nervousness is inherited? And how ought ner- 
vous children to be treated? 

Are such children generally more brilliant than other children 
of their age? 

Are vivid dreams always a sign of mental fatigue? 
24 



370 THE CENTURY BOOK FOR MOTHERS 

Nervousness is considered by most competent authorities on 
the subject to be more apt to be inherited than almost any 
other infirmity, and the children of parents who are of a ner- 
vous disposition are therefore doubly exposed to those influ- 
ences which produce nervousness. As the imitative faculty 
is very strong in children, such parents should be careful to 
suppress any eccentricities of gesture and temper that they 
themselves may indulge in, lest the children acquire them in 
an exaggerated form. In dealing with nervous children ex- 
cessive tenderness and sentimentality are as injurious as ex- 
cessive harshness. 

Nervous children are very apt to appear endowed with 
brilliant talents at an early age, and the parents in their not 
unnatural pride often encourage this brilliancy, instead of 
restraining it and allowing the brain to take a normal course 
of development that will not lead to premature exhaustion 
or collapse. In other cases, almost as frequent, nervous chil- 
dren appear to be endowed with less than normal mental 
gifts, and in these cases it is quite as injurious to force and 
urge them on in the vain struggle to overtake their more 
gifted companions. The victims of such a mistaken policy 
often become confirmed invalids in after-life. 

Vivid dreams, especially Avhen they are of a disagreeable 
nature (as most vivid dreams are), are quite as fatiguing as 
real experiences. Consequently the brain gets no rest, or 
but little, during a sleep disturbed by such dreams. Avoid 
everything that may excite the child during the day, and 
especially near bedtime. For the same reasons— speaking oi; 
older children— nothing can be more reprehensible than 
the habit of allowing them to sit up late, or of taking 
them to entertainments in the evening. Quiet sleep, fresh 
air, and, in certain cases, judicious use of cold baths, are 
the best medicines for nervousness in children within the 
range of domestic practice. It is worth remembering 
that overfeeding, especially late in the day, may disturb 
sleep. Sometimes one bottle less in the day is the needed 
change. 



HYGIENE AND SANITATION 371 



THE HARDENING THEORY 



I should like to ask you a question about our fourteen-months- 
old baby daughter. She is doing very well in every way, and 
is considered by all who see her a strong and well-developed 
child. She is, however, subject to colds. My husband is a 
believer in the hardening theory, and thinks that it would be 
well for her to get a cold bath every day, summer and winter, 
even when she seems to have a running cold. I should like 
your opinion on that subject before cooler weather sets in. 
She enjoys the cold bath very much at present. 

To begin with, we have no opinion of the "hardening" the- 
ory except that, as generally interpreted, it is a great stu- 
pidity. We do not of course mean to advocate foolish cod- 
dling. The ''hardening" method in any shape should not 
be begun on a little child. ■ As to the cold baths, we note 
that you do not mention the kind of bath, but we presume 
that you mean an immersion bath. ''Cold" bath is used 
very vaguely in common conversation, but to a medical man 
it means a bath between 50° F. and 70° F. Now, a bath 
drawn from the cold tap in New York City, in the middle 
of a warm July day, is about 70° (if there has been a pro- 
longed "hot spell" it will mark something higher). This 
even gives a distinct chill when one enters it, which is soon 
lost to a strong adult; but the baby's surface area is much 
greater in proportion to its mass than the adult's, and it is 
in the same proportion more easily chilled. Suppose baby 
weighed twenty pounds, and his father one hundred and 
sixty : baby 's mass to the father 's is 1 : 8 ; his surface is 1 : 4, 
and he chills twice as fast, making no allowance for the rela- 
tively greater impressionability of the child 's nervous system, 
which still further exaggerates the disparity. As the tem- 
perature of the bath is lowered, the depression is proportion- 
ately greater. In fever the cold bath, used with discretion, 
and by those who know its effects, is a valuable remedy, but 
it is potent for mischief if used stupidly. 

As to "hardening," once more we w^ould say that we do 



372 THE CENTURY BOOK FOR MOTHERS 

not think well of cold baths, in the usual sense, for an infant 
or a little child. If the immersions are only for a few sec- 
onds they may do no harm, but in our opinion, in cool weather 
at least, a better bath for the purpose is this : Stand the child 
in lukewarm water no more than ankle deep, and sponge it 
over with water of about 70° F. from a bowl at hand. Any 
necessary washing wdth lukcAvarm water and soap to cleanse 
soiled parts of the person is to be previously done. By this 
method all the advantages of the cold bath are gained, with- 
out its drawbacks. 



HARDENING IN PRACTICE 

I have two boys, aged three years and eight months and five 
years and four months, who have from about the fourth month 
of their lives been accustomed to a daily cold bath. In sum- 
mer I use for them the water as it comes from the faucet, 
in winter I raise the temperature to 70° for the younger boy 
and to 60° for the older. They not only enjoy their daily 
bath, never experiencing a chill, but often — even in winter — 
beg for "more cold," and consider it a treat when the cold 
water is turned on and they are allowed to put their head and 
neck under the faucet. 

Now for the practical side of it. Neither boy has ever been 
seriously ill, the older has had only a slight attack of the 
measles, and both are remarkably free from even ordinary 
colds. Must I look for dire results in the future, as a conse- 
quence of my hardening theory and practice? 

No. You are not to ''look for dire results." It happens 
that you have a pair of children who can stand the regimen, 
and we know a good number of such ; but we know a great 
many more who cannot. The same argument which is ad- 
duced for ''hardening" is also used for violation of every 
rule of diet. "See my child!" exclaims the proud parent. 
"Ever since he was off the bottle he has eaten whatever was 
on the table. Does he not look well?" This is the rule of 
life in a large class of the community, where a high infant 



HYGIENE AND SANITATION 373 

or child mortality is looked on as normal. But in advising 
our readers we advise what we believe (and in this we find 
we agree with the almost unanimous opinion of those who 
study the hygiene of childhood) is best for the great major- 
ity. A\"herever a child shows greater vitality than is usual, 
or less susceptibility to morbific influences, there is no need 
for him to be as carefully kept as others. 



RATIONAL AND INJURIOUS SCHOOL-WORK; THE 
SCHOOL LUNCH 

Is it injurious for young children to do their lessons in the 
evening? How many hours ought a child of eight to spend 
in such work? How can one tell whether a child is over- 
worked? What is a proper school lunch? 

If by "young children" is meant those under ten, thej^ have 
no evening. They should be in bed at 8 p.m. The little in- 
terval between their evening meal and bedtime should be 
spent quietly preparing for a restful night. 

The school day of a child of eight does not exceed five hours 
in the public schools, in private schools usually less. This 
includes study, recitations, and everything. Outside study 
is not expected, and rightly. The writer believes that nearly 
all the symptoms of overwork in school are due to other causes 
and occur about the same whether the child attends school or 
not. They coincide with the developmental age. If there ap- 
pear any signs of ill health it is proper to consider the cause, 
but not to assume over-study until every sort of mal-hygiene 
has been considered. We have known a child removed from 
school, by medical advice, as overtaxed, when the physician 
had been kept in ignorance of the fact that the child had a 
standing order at the grocer's for a daily supply of indigest- 
ibles sufficient to upset a whole nursery. And these instances 
might be adduced indefinitely. The chances are entirely in 
favor of a bodily and not a mental cause of the fagged con- 
dition of the pupil. 



374 THE CENTURY BOOK FOR MOTHERS 

The proper school lunch— still considering young chil- 
dren of eight or thereabouts— is a light one. Plenty of time 
must be given for breakfast. The midday meal must be 
ready when the child comes from school. The lunch is only 
a snack about eleven o'clock— bread and butter, a few bis- 
cuits, with an orange or an apple, or a similar ''life-saving 
station" is all that is desirable. If school is arranged so 
that there is an interval to go home for lunch, then the ques- 
tion solves itself— the lunch is a good warm luncheon. If 
the hours do not permit the eleven-o'clock snack, and a 
heavier luncheon must be carried to school, it will depend 
upon the condition of things at home just what it shall be. 
But it must be simple; it must be nutritious and digestible 
—good bread and butter, either alone or in the form of a 
sandwich made with a thin slice of tender meat or mince. 
No pie or cake; fruit should be used in its place. Try to 
make the child's luncheon look tasteful and inviting, and 
teach him to make it so himself, if practicable. Have a 
lunch-basket, if possible; not one of those close tin lunch- 
boxes, without ventilation, which gives to the best luncheon 
an unpleasant odor. All these niceties promote appetite and 
digestion. Details as to luncheon cannot be given. The 
conditions of a town child whose home is only five squares 
from the school are not the same as those of the country 
child, who has to make a long journey to the school-house. 



OVER-STUDY AS A CAUSE OF CHOREA 

My little girl of ten shows symptoms of St. Vitus's dance. 
Should she be taken out of school? And is it likely that ex- 
cessive study is the cause of the trouble? 

School life has been charged with a considerable influence in 
the production of chorea. There is no doubt that a choreic 
child should be relieved from enforced use of its eyes and 
from the often inconsiderate society of its schoolmates, but 
that school life or study is very often the main factor in the 



HYGIENE AND SANITATION 375 

cause of the disease we must doubt. Its greatest frequency 
coincides with the developmental age— six to fifteen— and we 
believe that it is as likely to occur in children out of school 
as in. The frequency with which the disease appears in 
spring has been thought to depend upon the fatigue of the 
preceding winter 's school work. "\Ye believe that it should be 
charged rather to the defective hygiene of the winter, and 
very probably to the enforced abstinence from fresh, espe- 
cially green, vegetable food through the cold months. 



I 



XXII 
QUESTIONS OF DRESS 



THE KNITTED BAND; GETTING RID OF THE 
PINNING-BLANKET 

Can you tell me how large to make the knitted bands for an 
infant ? I have but one child, and, as he was dressed the old- 
style way with many bands, I thought that I could do much 
better with the Gertrude suit. 

I would also like to ask how they do with the pinning-blanket 
— make it like a skirt or leave it off altogether? I suppose 
that you will tell me to let the band go after the first month 
or so, but my boy, now eight years old, had severe trouble with 
his bowels, and if I took off the flannel band he would be much 
worse. I also used the band to button the stocking-supporters 
on, using the supporters as soon as he was put in short clothes. 
He wore long woolen stockings, keeping his knees and legs 
warm. 

A knitted band should be rather loose; one that is tight 
enough to hold up stockings is too tight. Its only use being 
for warmth, it should be wide enough to cover the whole 
abdomen, say from just below the breast to the hips. 

One of the merits of the Gertrude suit is that it gets rid 
of the pinning-blanket. 

SEASONABLE DRESS FOR A FIVE-MONTHS-OLD; 
SILK OR FLANNEL? 

My baby is five months old, and has always worn long-sleeved 
and high-necked silk shirts, but I find that his arms and shoul- 
ders are generally cold. Shall I put flannel on him instead? 

376 



QUESTIONS OF DRESS 377 

What should be the day garments for spring? When summer 
comes should I make any difference? 

Silk is cold wear for winter, and, Avhen damp with perspira- 
tion in summer, clings disagreeably to the skin, besides be- 
coming almost as impervious as oiled silk to air and moisture, 
and thus hindering the action of the pores. Fine silk-warp 
flannel is better wear for all seasons, certainly for Avarm 
weather. Lighten his upper garments, should he suffer from 
heat, and exchange the damp for dry flannel. 

Garments for spring should be the same as for winter, but 
of lighter material. Substitute short-sleeved and low-necked 
shirts for those he noAV wears when the heats of summer be- 
gin. Be careful not to leave off the flannel skirt and band 
too early in the season. Wait for July days for this. 

NIGHT COVERINGS 

What shall I do to keep my baby boy warm at night? What- 
ever I do, he will get outside the bed-clothes. I fear that by 
doing so in winter weather he will get pneumonia. He has 
recently had a severe cold, taken in that way. A few weeks 
ago I put flannel night drawers, with feet, on him, and con- 
sider them a very good article, but that is not enough cover- 
ing. I have thought somewhat of making a large flannel bag 
to put him into, and yet that does not seem exactly a com- 
fortable thing. 

Besides the sleeping-drawers we are in the habit of advising 
one of two things: The careful securing of the covers by 
tapes or strong safety-pins— large sizes are made for the 
purpose— or the blanket bag you suggest. The latter, you 
probably know, is the plan pursued by explorers and hun- 
ters in cold weather. As a baby's napkins must be changed 
at night, the bottom of the bag may have a flap to button 
over, in which case it is really only a nightgown closed at 
the bottom. It should be made very wide to permit free 
movement of the limbs. 



378 THE CENTURY BOOK FOR MOTHERS 

THE NIGHTCAP; STOCKINGS AT NIGHT 

Should a baby with little or no hair, inclined to perspire about 
the head and neck, wear a nightcap? Should he wear stock- 
ings at night? Can any rule be given as to the amount of 
bundling and wrapping a young baby requires? 

We know of no use for nightcaps. The child can be better 
protected from draft in other ways. The stockings are not 
necessary if the bed-clothes are suitable and kept in place. 
The only rule is evenness of protection and sufficient warmth 
without burdensome weight. 



SUMMER DRESS 

I should like to ask you how I shall dress my baby boy of eight 
months in the summer so that he may be warm enough and 
not too warm; he seems to feel the heat very much. Would a 
Canton flannel nightgown that has been worn in winter be 
too warm? Ought he to wear merino stockings, as he is 
doing now, or will cotton ones be better? 

A loose and ample garment, with shirt, napkins, and stock- 
ings under it, will be enough in hot weather. Cotton stock- 
ings have no particular advantage as to coolness over merino 
if the former are sufficiently stout to be of any use to a 
strong baby ; so we think that, all things considered, you will 
find the advantages on the side of the merino. The Canton 
flannel will not be too warm, but woolen flannel is more por- 
ous and generally more comfortable. If night-drawers closed 
at the feet are used, no other cover is needed in very hot 
weather. 

SUMMER NIGHT-CLOTHING 

Will you advise me what material for night-clothes you would 
consider best suited this summer to the needs of an eighteen- 
months' child, who will pass the season at the seashore and has 
still the stomach teeth to cut? 



QUESTIONS OF DRESS 379 

A light, fine, cotton-and-wool flannel makes the best sum- 
mer night-garments. AVith proper washing it does not full, 
and it is in every way safer than muslin for the seashore, 
and but little warmer. 



CLOTHING FOR WINTER 

What is the wisest way to dress a child in winter? I do not 
approve of the little thin white dresses, and want my little 
girl to wear fleeced pique'. 

The garments should be planned so as to make an even cov- 
ering for the whole body, and should be such as to seem 
comfortably warm to you for your house and climate, with- 
out overloading the child. All babies and children in our 
winter should have thick woolen undergarments. The heav- 
iest all-wool merinos that you can find of children's sizes will 
not be too warm. They should be high-necked and long- 
sleeved, and long in the body. Long woolen stockings, held 
up by side supporters, are an excellent protection, and, if 
possible, let the child wear flannel drawers also, for the skirts 
fly about and cannot be depended upon. The legs of the 
drawers can be made separate to button on, if more conve- 
nient. Then comes the cotton waist, which helps to protect 
the chest and holds the flannel skirt and drawers. The 
fleeced pique would be comfortable, but, with an extra flan- 
nel skirt and flannel sack underneath, the thin dresses can 
be made perfectly safe. A few house sacks are useful when 
the rooms happen to be cooler than usual, but should not be 
habitually worn. 

For out of doors have a thick hood, or a hat which will 
cover as much of the head as a hood, with warm, broad ear- 
pieces, fitting closely, and a heavy cloak. If the child walks 
she should have thick soles and leggings. If she rides she 
should have plenty of blankets snugly tucked around her 
under those used chiefly for ornament. Warm mittens are 
very important, and care should be taken that they are kept 



380 THE CENTUEY BOOK FOR MOTHERS 

on if the weather is cold, for the child cannot be comfortable 
if the hands are chilled. 



THE VALUE OF LONG STOCKINGS 

I should like to put my baby in short clothes in June, and wish 
to ask what kind of socks I should put on him? One friend 
says cotton, another says merino by all means through the 
first summer. If the latter advice be followed, will there not 
be danger in changing to cotton ones later ; or would this neces- 
sitate putting on cashmere ones as the cold weather approaches ? 

My oldest child wore merino and then cashmere stockings, but is 
subject to spasmodic croup. Is there any truth in the state- 
ment that woolen stockings cause a tendency to croup by mak- 
ing the feet perspire ? If this be true, I want to guard against 
the second child being made a subject for croup. 

When the baby is put in short clothes he should have stock- 
ings long enough to cover the leg and knee and even higher 
if the napkins will permit. The short sock commonly 
used on babies has no value except to keep the shoe from 
touching the foot ; it generally leaves the calf and knee bare 
if the child moves his legs enough to throw off his skirts. 
We are persuaded that the secret of healthful clothing is 
the uniform protection of the body ; hence a method of dress 
that leaves open patches of the person between thickly clothed 
ones is more hazardous than simple nudity. A child should 
not be burdened with clothes, but the protection should be as 
evenly distributed as possible; hence the advice about the 
length of the stockings. 

As to materials, we prefer those that have a considerable 
amount of wool. "Merino" is a trade name for knitted 
goods containing both cotton and wool, apparently in vary- 
ing proportions. ''Cashmere" we are not quite certain 
about, but we think it is mainly wool with some cotton. The 
reason for preferring wool is that through it changes of heat 
and cold are less quickly felt. It has been found that light 



QUESTIONS OF DRESS 381 

woolen fabrics make the most comfortable as well as the safest 
summer apparel. 

We do not believe that croup comes from the cause as- 
signed. If the shoe is sufficiently large the woolen stocking 
does not cause perspiration, and, as already said, a change 
of temperature or a draft of air, which are the usual causes 
of a checking of perspiration, are much less readily felt 
through wool than through cotton. 

STIFF SOLES FOR BABIES 

At what age should a child wear stiff-soled shoes ? Our baby has 
worn kid shoes, with soft soles, since he was seven months old. 
He is now one year, but has never shown any inclination to 
walk or creep. He is large for his age, strong, and healthy. 
Will a stiff sole injure the shape of the foot? 

The stiff sole is not necessary until he begins to walk out of 
doors ; it then is useful to prevent bruising of the foot. The 
stiffness of the sole, if the shape is right, will not change the 
shape of the foot; but, unfortunately, the shape of baby 
shoes is not always right, although they are usually less 
atrocious than the soles made for adults. 

GARTERS AND STOCKING-SUPPORTERS 

What do you consider best for children, the round garters, above 
the knee, or the stocking-supporters attached to the waist? 

The objection to the circular garter worn above or below 
the knee is, of course, that if tight it interferes with the free 
return of blood from the leg. The objection to the waist 
stocking-supporter is that if tight it draws forward too much 
on the loins. Now, practically, neither does harm if not 
too tight. If one tries to keep a silk stocking up next the 
skin or upon slippery underclothing, a tight garter of either 
kind is needed to keep the stocking free from folds. But 



382 THE CENTUEY BOOK FOR MOTHERS 

as children dressed for comfort and not for show generally 
have in cool weather drawers of woolen or some knit goods 
and stockings of wool or some substantial material, the stock- 
ing is readily kept in place with very slight pressure. Very 
little, for instance, is required to keep the stocking of the 
bicyclist or sportsman in place. In our judgment, the stock- 
ing-supporter is preferable if the garter must be tight, but 
if the child is properly dressed it makes little difference. 
You should yourself see about the snugness of fit. 

In the case of the Gertrude suit, if you prefer the sup- 
porter, you can put supporting buttons upon the inner gar- 
ment of the suit. 



PROPER STOCKINGS AND SHOES FOR A 
DEPRESSED TOE 

When my three-year-old boy was born, we noticed that the toe 
next the big one on the left foot was inclined to turn under 
the next one. He wore chamois moccasins till a year and a 
half old, and then broad- toed shoes; but I find the toe is not 
getting any better; the big toe seems to push over and almost 
meets the third toe, leaving the second quite underneath. It 
does not seem to give him any pain now, but I fear will do so 
later — the nail seems to pass almost through the flesh. 

Is there anything I can do for it? We thought perhaps stock- 
ings with separate toes might be an advantage, but do not 
know if they are made for children — can you tell me? 

Also, can you tell me where to get shoes without any heels ? He 
is wearing the largest size of infant's shoes, and the next size 
has spring heels. I cannot see why, if shoes with no heels are 
best for little children, they are not always best ; and then they 
all have such thin soles. I have used cork soles in my boy's 
shoes all winter. 

The toe may have had, and probably did have, some con- 
genital peculiarity. The management of such toes often re- 
quires considerable ingenuity. The intruding, overlapping 
toe must be kept in place. Various devices have been used, 



QUESTIONS OF DRESS 383 

and which particular one is best adapted to this case we 
cannot tell by description. Often, too, after the depressed 
toe has occupied such a position for a time, it will be neces- 
sary to raise it by a strip of adhesive plaster or in some other 
way. You can do a good deal, but you will work best if you 
have the advice of some good physician of your neighbor- 
hood. Get that one who has the most surgical or mechanical 
''knack." The stockings with separate toes are usually knit 
to order, we think. 

The "spring heel," meaning only a thickening of the sole 
at the back, is harmless. The essential reason, we appre- 
hend, why no heels are used for any young children is to 
allow them as free movements of their feet as possible until 
they get control of them. They stumble and fall very read- 
ily at best. Any stiff sole would aggravate this tendency; 
later, they can manage a stiffer sole, and the spring heel is 
only a slight additional protection to the sole of the foot. 
The thinness of the sole need not be prolonged after children 
have good use of their limbs, but you must not expect the 
shoemaker to make innovations unless loudly demanded. 
Shoes are made to sell, and the shoemaker is a merchant, not 
a physiologist, nor usually a philanthropist. 

THE ADVISABILITY OF GOING BAREFOOT 

What is your opinion of letting infants and children go bare- 
foot? In a climate like that of Texas, where, as some one 
said, it is nine months summer and three months very late 
spring, children seem to do this with impunity. I hesitate, 
however, and would like to know your opinion as to the ad- 
visability of getting near to Mother Earth. 

The climate of Texas we know only by hearsay. The feet, 
if exposed persistently, become hardened on the sole and less 
sensitive than if covered. Apparently, country boys suffer 
but little from the exposure to cold. In an equable, warm 
climate it is probable that there would be less risk than in 
colder or more variable ones. One of the objections to going 



384 THE CENTURY BOOK FOR MOTHERS 

barefoot is the susceptibility to injury. Any one who went 
barefoot in his childhood will recall the painful ''stone 
bruises, ' ' often suppurating, from which he suffered. If the 
plan of going without shoes is adopted, it should be com- 
menced after the summer has really begun. It is easier and 
safer to continue as the weather grows colder than to begin 
too early. 



XXIII 
CARE OF THE MOTHER 



NERVOUSNESS IN THE MOTHER AS A CAUSE OF 
BABY'S COLIC 

My second baby was from birth very troublesome. He was un- 
easy and fussed and cried the greater part of the day, and 
invariably had a spell of colic in the evening, after which he 
would settle for the night. This continued for five months, 
when the colic spells became less frequent, but the restlessness 
and lack of regular habits, except in nursing, continued until 
he was weaned at ten months, at which time he weighed twen- 
ty-five pounds nude. 

Every effort was made to find the cause, and many remedies were 
used to cure the colic, which was severe. My diet was given 
special attention. I systematically eliminated one article of 
food after another which I thought might cause the trouble. 

My third baby was from birth until the nurse left what mothers 
call "a dear, good baby," but after I began to care for her she 
gradually developed the same symptoms as baby number two, 
but with less severe colic. Again I looked to my diet, with the 
same result as before. I was in despair. 

I consulted my physician, as I had with my former baby, but 
this time he prescribed for me — harmless sedative tablets for 
nervousness. The effect was immediate. Baby resumed her 
happy existence, and now, at five months, eats and sleeps well 
and regularly in spite of the fact that I eat everything I desire. 
Even such articles as baked beans, boiled onions, or turnips 
(which I began to eat with fear and trembling) do not disturb 
her in the least. 
25 385 



386 THE CENTURY BOOK FOR MOTHERS 

I firmly believe, as does my physician, that if the same treat- 
ment had been followed with baby number two he would have 
been spared much misery and the whole household much worry. 

The question of the effect of the mother's emotions or ner- 
vous state is an old one. The books give cases of very great 
damage done to infants by nursing after the mother had 
undergone strong emotions, notably anger. It may be said 
that these cases are not recent and have not the preciseness 
in detail that modern science demands. Yet we think that 
there is no doubt that nervous disturbances on the mother's 
part do cause symptoms of indigestion in the infant. Just 
what changes occur in the milk is not known. Opportuni- 
ties are usually too rare to enable the chemist to make the 
delicate analyses which might show the nature of the changes, 
and it is very probable that the latter would be beyond our 
present means of detection. If, however, Ave reflect that emo- 
tions will affect all of the secretions— perspiration and urine, 
for instance— will change the action of the bowels, will cause 
nausea and vomiting, the fact that the milk should be simi- 
larly modified does not seem remarkable. 

In practice it is well to consider two things in the mother's 
condition: First, her general condition of health as modi- 
fying her nervous state, and individual occasions of nervous 
excitement or irritation. A general nervous condition will 
be likely to give rise to pretty steady disturbance on the part 
of the child, and this condition can be best treated as it was 
in the case of our correspondent. When some single source 
or occasion of nervous excitement in the mother has once pro- 
duced trouble in the child, it will be well to be on guard if 
such excitement occurs again. One of the best remedies in 
common use is asafetida. Its odor is disagreeable, but its 
value as a soother of disturbed nerves is established. For- 
tunately, it has the additional advantage of being a notable 
remedy for colic in infants. A still further advantage is 
that it is not poisonous, and is laxative rather than consti- 
pating. 



CARE GF THE MOTHER 387 

WTien, however, the question of a child's colic being due to 
the mother's nerves comes up, in every case all other causes 
should be considered also. Thus, it may be difficult to show 
—as in our correspondent's case— that her food affected the 
baby. In fact, we believe that, as a rule, if the mother's 
food be well digested by herself it is not likely to hurt the 
baby. But in this very case we note that the child at ten 
months weighed twenty-five pounds nude— a very heavy 
weight— which makes one wonder if the colic may not have 
been partly due to overfeeding. Fussiness with rapid 
growth is very suggestive in this condition. Probably it ex- 
plains many of the common cases of colic which torment the 
baby and its mother for three months and then cease. The 
milk-supply was beyond the digestive power of the young 
baby, but it eventually caught up with it. 

A SENSITIVE BREAST 

My baby is seven and a half months old, weighs seventeen 
pounds, and has two teeth started. She has never been sick, 
but has always been constipated, having only one movement a 
day after an injection of glycerin and water (one half tea- 
spoon). I nurse her, and occasionally I feel a pricking sen- 
sation in my nipple, after which baby draws blood with the 
milk, resulting in a black movement. It does not seem to 
affect her otherwise, but I know something must be wrong, 
and ask your advice. 

It is probable that the pricking sensation followed by blood 
is from a slight wound, whether from a bite or from too pro- 
longed or too hard sucking we do not know. If it seems to 
be from the latter cause, perhaps it could be avoided by 
changing to the other breast before the sensation is felt. If 
it occurs only on one side, better let the baby feed first from 
the other side, so that she shall not pull so hard on the tender 
side. A shield may prevent this trouble. If it fails, wean- 
ing is the cure, and it may be begun early if the breast is 
often hurt— that is, often enough to keep it sore. 



388 THE CENTURY BOOK FOR MOTHERS 



SORE NIPPLES 

My baby is bottle-fed because of the suffering caused by sore 
nipples and two gathered breasts, the milk having been so 
transformed by my nervous terror from the pain that it nearly 
killed her. Do you know or can you safely recommend a cure 
for sore nipples? 

' ' Sure cures ' ' rarely exist out of the realm of popular medi- 
cine. We have none to offer. But careful attention to the 
following details generally insures immunity or speedy cure. 
The usual causes of sore nipples are two. First, want of 
development of the nipple, which makes it difficult for the 
child to nurse without violent sucking; a similar condition 
results from flattening of the nipple from pressure by a cor- 
set for years, the nipple becoming broad, but not prominent 
enough for the lips to grasp it. The second cause is want 
of cleanliness— not want of ordinary cleanliness, but of ab- 
solute cleanliness, or, as the medical phrase is, "surgical 
cleanliness." It may be said at the start that some persons 
—particularly persons subject to eczema— seem to have a 
greater tendency than others to these nipple troubles. 

When the nipple is not well developed or is flattened, 
much may be done during the later months of pregnancy to 
elongate it by gently but persistently drawing it out and 
at the same time pressing backward the darkened skin (are- 
ola) around it. If at the same time the surface of the nipple 
seems to be tender, it can often be hardened by frequent 
bathing with alcohol or with some astringent solution, such 
as alum- water, alcohol and alum, witch-hazel extract, and the 
like. Occasionally a person is found whose skin does not 
tolerate these applications, but in the great majority of cases 
they agree and are beneficial. But no preliminary prepa- 
ration will be effectual if the details of toilet of the nipple, 
presently to be spoken of, are not heeded. ^ 

Sore nipples are of two kinds, those that are tender or 
excoriated (''raw") and those that are fissured or cracked. 



CARE OF THE MOTHER 389 

The prevention and much of the curative treatment are the 
same for both. The former are usually made tender first 
of all by the oozing of the watery liquid that precedes the 
milk. This, with the moisture of baby's mouth and a little 
milk (when it has come) left after nursing, if not removed 
with the utmost care, will remain in the minute folds of the 
nipple skin and soon set up an irritation. At first, to the 
naked eye, or even with a magnifying-glass, nothing is evi- 
dent but a redness of the surface ; but this spot is exquisitely 
tender, and many women who have bravely borne the suf- 
fering of labor shrink from the putting of the baby to the 
breast. This, if not promptly attended to, becomes a raw 
surface, and even more tormenting than before. 

Now, from the start the nipple should be kept scrupu- 
lously clean. It should be bathed before suckling and after 
it. Some mild and unirritating disinfectant should be used 
— boracic acid is our own preference— dissolved in the warm 
water employed for bathing the nipple. It Avill be worth 
while to examine the nipple, and particularly its base, for 
wrinkles and folds of the skin, because in these the ferment- 
ing liquids hide and set up the irritation. If such folds be 
found, they may be washed out by the aid of a camel's-hair 
pencil or a little wad of absorbent cotton. The parts should 
then be carefully dried, unless the attendant thinks it better 
to keep some soothing wash always on the nipple in the inter- 
vals of nursing. One authority advises the use of Goulard's 
extract— a teaspoonful to a tumbler of water— to be kept for 
several days on the nipple by means of a soft cloth, washing 
it carefully away before nursing. 

If but one nipple is sensitive the task is easier, for then 
the child may take the other for a day or two, the tender 
breast being carefully emptied by stroking and rubbing. 
Two days' rest of a nipple almost always results in a cure. 
AVhen, however, both nipples are troublesome, they require 
more attentign, but the rest of both breasts results in a dis- 
appearance of the milk altogether. 

The treatment of cracked nipples demands the same pre- 



390 THE CENTUEY BOOK FOR MOTHERS 

cautions as have been detailed. In addition, the fissures 
themselves often, if not usually, need local treatment; but 
as this can be well carried out only by the physician or a 
well-instructed nurse, it is not worth while to enter into it 
here. 

THE DIET OF A NURSING MOTHER 

What should a mother eat while nursing her baby, or what espe- 
cial things should she avoid eating'^ 

No explicit directions can be given. There is a very gen- 
eral belief among mothers that their articles of food may 
affect the suckling's digestion. There is nothing improbable 
in this, since we know that some drugs taken by the mother 
can be recognized in the milk; and certainly in cow's milk 
the taste of certain things— the turnip, for instance— eaten 
by the cows is often recognized. In practice, however, women 
are not harmonious in their opinions as to the kinds of food 
which do affect the suckling, and some medical men are 
skeptical as to the whole matter. For ourselves, we think 
the truth is about as follows: Any good wholesome food 
which the mother can ordinarily fully and easily digest— i. e., 
without distress, acidity, flatulence, or other evident disturb- 
ance — may be eaten, with perhaps the exception of such ar- 
ticles, chiefly vegetable, as contain a strong volatile oil 
or principle such as we can recognize by the taste in cow's 
milk. Such are the cabbage, cauliflower, turnip, onion, and 
garlic. Now, we are not quite sure that even all of these 
need in every case be avoided, for they certainly form a con- 
siderable part of the diet of nursing women in some walks 
of life. Whether in those cases they do not usually affect 
the infant, or whether a certain amount of disturbance of 
the baby's digestion is in those rather unintelligent circles 
considered as normal or unavoidable, we do not positively 
know. We should, however, advise the use of other things in 
preference ; and, in case these vegetables are especially craved 
or are needed as laxatives, that they be taken cautiously and 



CARE OF THE MOTHER 391 

the effects noted. There are many articles, notably starchy 
things— white bread, potatoes, beans, etc.— which some per- 
sons digest perfectly and others only with the formation of 
much gas. Concerning such there is no rule beyond indi- 
vidual experience. It Avould be a pity to avoid any food that 
is wholesome to the mother if it is not really disturbing to 
the child. 

AYe believe that all alcoholic beverages should be used 
sparingly and Avith great circumspection, unless ordered by 
a physician, in which case explicit directions as to the dose 
and the period during which they are to be used should be 
asked for. 

THE BEST METHOD OF DRYING UP THE 
MOTHER'S MILK 

^Vhat is the best method of drying up the mother's milk? 

Ordinarily, absolutely nothing is needed but to let the breast 
alone. If the breast fills, stroke or pump out the milk. Bel- 
ladonna ointment applied to the breast, however, hastens the 
disappearance of the milk and eases pain, but do not let the 
infant get any of the ointment in its mouth or eyes. It is 
very poisonous. 

"NURSING SORE MOUTH" 
Can you give a care for "nursing sore mouth"? 

The disease known as ** nursing sore mouth" is, fortunately, 
a rare one nowadays. Some thirty years ago it excited much 
discussion in medical journals in various parts of this 
country. It has been known to be epidemic where some 
bad climatic or hygienic conditions have existed. The dis- 
ease is probably always dependent upon anemia (thin blood), 
and it sometimes occurs before delivery, and has even at- 
tacked males. Authorities agree that the surest cure lies in 
tonics, iron, quinine, cod-liver oil, good food, and perhaps 



392 THE CENTURY BOOK FOR MOTHERS 

wine. One writer goes so far as to maintain that it is neither 
more nor less than scurvy. The best preventives are good, 
generous diet and good hygiene during pregnancy as well 
as during the nursing period. 



EXCESS OF ABDOMINAL FAT 

Is there any safe and practical way of removing superfluous fat 
from the abdomen? The nurses here never bandage after 
labor. Would that account for it? Immediately after the 
birth of each of my two children there has seemed to be no 
adipose tissue there at all. Before I am out of bed, however, 
it has begun to be deposited all over the surface of the abdo- 
men, and, alas ! it continues to come. My general health is 
good. I take much out-door exercise, and my diet is mainly 
meat and fruits, as I do not care for sweets or starchy foods 
of any kind, but the m.elancholy fact remains — and I fear 
the trouble will increase — twenty-eight inches waist, forty- 
eight inches hip ! I know this question has nothing what- 
ever to do with the care of babies, but as the trouble 
seems to have been caused in some indirect way by them, 
and as the subject will doubtless be of interest to others 
as well as to myself, I take the liberty of coming to you for 
help. 

The excess of abdominal fat after delivery is not dependent 
upon the absence of the bandage. We have often seen it 
occur just the same with the bandage. The peculiarity is 
in part constitutional. For its relief, diet will do something, 
kinds of food and amount of liquid both being considered. 
But during lactation a good deal of liquid may be needed. 
Further, we believe that systematic muscular exercise of the 
abdominal wall is useful, in that much of the protuberance of 
the abdomen is due not to the fat, but to the laxness of the 
muscles. We have knowledge of instances in which during 
a course of exercise several inches were lost in girth, while 
no weight was lost. Even if girth be not reduced, the mus- 
cular gain enables one to be more active. 



CARE OF THE MOTHER 393 

FALLING OUT OF THE HAIR AFTER CONFINEMENT 

In behalf of some of my friends, as well as myself, I want to 
know if you can give me any information regarding the pre- 
vention of the falling out of hair after confinement? I have 
very heavy hair, but after the birth of my little boy, two years 
ago, I lost fully one fourth of it, and it has not grown in to 
any length since then. Now, a frequent recurrence of this 
would be most disheartening. Is there any known treatment 
of the scalp, either before or after confinement, that could 
prevent this? 

AYe know of no way of preventing this peculiar fall of the 
hair, Avhich is of very common occurrence and very similar 
to that following severe illness, particularly if attended with 
fever. Fortunately, the hair usually returns as fully as be- 
fore; but as a very long time— many months, or even some 
years— is required for it to gain the great length seen on some 
women, the frequent recurrence of pregnancy might prevent 
its reaching its original length. Applications to the scalp 
are useful if there is a recognized disease of the scalp ; but 
in cases where there seemed to be no local disease Ave have 
not been able to see that the growth of the hair Avas more 
rapid after using the most approved local applications than 
in those instances in which none AA^ere used. 



XXIV 

SPECIAL REQUIREMENTS AND PERPLEXING 
POINTS IN THE NURSERY ROUTINE 

CRYING AND SEDATIVES 

To what extent is crying harmless in babies? The cry of a 

baby is its voice. If this were stifled it could not make known 

its discomfort or pain. 
Should sedatives be given? When? In what quantities? What 

is a safe preparation? 
When an infant of a few days, say two weeks, sleeps well during 

the day, but cries at night, how can the natural relation of 

day to night be restored? 

This can be answered only in a general way. The baby has 
''no language but a cry" in one sense; but it does not ''cry 
for joy." If a baby cries, it signifies that things are not 
as it wishes in some particular. Of the various cries of in- 
fancy many are usually easily recognized, or at least have 
been catalogued by nurses long ago. Pain, weariness, sleepi- 
ness, fright, etc., are among the causes assigned to different 
cries. To many children the cry is not harmful, but the 
cause of the cry— pain or fright, for instance— is. We pre- 
sume our correspondent wishes to know when crying is of 
itself harmful. It rarely is so. Children occasionally "cry 
themselves hoarse," and, also rarely, a fit of crying may ex- 
cite vomiting if the stomach be full ; but neither accident is 
very important. Of more importance are the fatigue and ex- 
citement dependent upon excessive crying. Violent fits of cry- 

394 



PERPLEXING POINTS IN THE NURSERY ROUTINE 395 

ing are assigned as a cause of rupture (hernia) in infants, 
and possibly correctly. It is not easy to describe the various 
cries of infancy. Their interpretation is learned by watching 
the child. The main point is to make sure, if possible, whether 
any removable hurt is the cause of the outcry. See if pins 
are pricking the baby or if it is too tightly diapered or 
clothed. Try also to see if it has colic or indigestion, and 
so on. 

By '' sedatives" we presume is meant not what are called 
such by physicians, but anodynes (relievers of pain) or 
hypnotics (sleep-producers). Neither the one nor the other 
should be given under any circumstances without medical 
advice, which should be specific as to dose and time and occa- 
sion of repetition. There is no safe preparation for infants 
or young children without such advice. 

The process of correcting bad sleeping habits is often very 
difficult, and taxes the ingenuity of the nurse; but usually 
the monthly nurse can get the baby well started, and she 
should, if she has been successful, explain her methods mi- 
nutely to the mother. The secret of success is not in drugs, 
but in systematic and regular methods with the baby. 



HARD CRYING AS A CAUSE OF RUPTURE 

Will hard crying cause a baby to be ruptured? 
Have you known of such a case personally? 
Is it common ? 

It is a common popular belief. But we think that hard cry- 
ing has not this effect without other cooperative causes. 

We can recall no case in which the relation of cause and 
effect was clear. Thus, while rupture may be produced in 
almost any one, it is most commonly produced in those whose 
abdominal apertures (the inguinal and femoral rings of the 
anatomists) are less well protected than in others. Again, 
while we think that a normally constituted infant would very 
rarely, if ever, rupture himself by crying if the abdomen 



396 THE CENTURY BOOK FOR MOTHERS 

were free, he can easily do so if all the elasticity of the middle 
part of the belly is destroyed by a tight girdle, as the ' ' band ' ' 
often is when tightly applied. It becomes then a point of 
resistance, the pressure of any strain is concentrated upon 
the bottom of the belly, and rupture is favored. 

Rupture is common enough, but, as we have said, we do not 
think it common from crying. 

ROCKING THE BABY 

What are the physiological objections to rocking a baby? Is it 
likely to produce congestion of the brain? 

The objections, in the main, are not physiological. We do 
not believe that gentle rocking is, save in exceptional cases, 
harmful; but, on the other hand, it is not beneficial. The 
simple holding of the child, by the support and warmth 
given, is as quieting. The chief objection to rocking a child 
is the habit that is formed of going to sleep in an unnatural 
w^ay. Sleep comes naturally to the tired child as soon as it 
is free from discomfort and is left alone. In saying the 
above we do not mean that the jolting or violent oscilla- 
tion of a child whose stomach is full is harmless; we believe 
that favors indigestion. 

AGE FOR SITTING UP IN THE CHAIR 
At what age is it safe for a baby to sit up in its chair ? 

The age at which a child can sit up varies much, and de- 
pends entirely upon its strength. We do not like chairs for 
very young children, because of their want of even support 
and their insecurity. A child should be allowed change of 
position from birth, and change of posture as soon as he can 
change it himself or shows a desire to change. To this end 
we like to bolster a baby up, on a bed for instance, with 
pillows. His head and trunk are then well supported, and 
the change becomes a pleasure and not a tax. 



PERPLEXING POINTS IN THE NURSERY ROUTINE 397 



BABY IN THE CORNER 

Do you think it injurious for a baby to sleep in a corner? Our 
room being very small, it is a case of necessity that baby's 
crib should be in a corner. We always have one of the win- 
dows raised several inches at night for ventilation. 

There are corners and corners. If a room is badly venti- 
lated, corners are ordinarily the least ventilated parts. If, 
on the other hand, the room is one, such as is often seen in 
poorly constructed country houses, which is the arena of 
contending drafts, a corner may be the least dangerous part 
of the room. A small room with a window open ought, we 
should suppose, to be sufficiently ventilated to render the 
air in the corners safe. Another aspect of the question is 
this : If the corner be one between two external walls, it is 
likely to be chilly, if not damp ; an inside corner made by 
lath-and-plaster partitions would not be open to this objec- 
tion. As your room is small, it presumably has sufficient 
light as well as air. 

PLAYING ON THE FLOOR 

I have two little ones, the elder four years of age and the younger 
just walking alone. Our house is heated by a furnace, but 
there always seems to be a cold draft upon the floor, where my 
children are inclined to spend most of their time with their 
toys. Can you suggest a plan whereby I can manage to keep 
them amused off the floor, or is there any way of stopping the 
drafts? 

\Vhile heated air rises and cold air falls there must always 
be a chill current near the floor. Drafts from without may 
be partially excluded by weather-strips and sand-bags, but 
baby sitting on the carpet is almost sure to take cold in 
bitter weather. A cheap mattress, covered with a quilt or 
shawl, makes a safe place for him on windy days. One 
mother had a sort of dais or platform, six feet wide and six 



398 THE CENTURY BOOK FOR MOTHERS 

inches high, mounted on rollers and set against the wall of the 
nursery, for "baby's room." In default of these conve- 
niences, give the twain chairs and low tables of their own, 
and teach them to use them instead of sitting on the carpet. 



THE EFFECTS OF "JOSTLING ABOUT" 

Will you tell me if you think it injurious to the nervous system 
of infants under six months of age to be jostled about in baby- 
carriages, baby-jumpers, etc.? 

We do not know that such jostlings are injurious to the 
''nervous system," as physicians use that name— that is, in 
its anatomical sense— but we believe they do increase the 
timidity and excitability of children, or, in other words, make 
them "nervous," especially if already inclined that way. 
We do not, for various reasons, think a baby- jumper fit for 
a child under six months of age; and at any age a child's 
carriage should be trundled with care and without unneces- 
sary jolting. 



RAPID CARRIAGE-DRIVING FOR VERY 
YOUNG CHILDREN 

Is it wise for babies at the age of six weeks or two months to 
be driven over country roads with fast horses? I mean 
can the violent exercise cause any injury to so young a 
child? 

Unless the roads are unusually smooth or the vehicle unusu- 
ally easy such exercise is undesirable. It is comparable to 
the jolting method of our grandmothers, when a rockerless 
chair was made to act as if it were a rocking-chair. If a 
young child is taken in a vehicle, it should be snugly held 
against the breast if rapid driving is necessary. Under such 
circumstances it should be protected until it is old enough 
and strong enough to steady itself. 



PERPLEXING POINTS IN THE NURSERY ROUTINE 399 

METHODS OF LIFTING THE BABY 

Will you please tell me how a child should be lifted? 

A baby can be best lifted from a horizontal position by put- 
ting one hand under the neck and shoulders (or shoulders 
alone after the neck becomes strong) and the other under the 
hips or seat. And it is always well to support the back when 
practicable. It often will, however, be necessary to put the 
hands for a moment under the armpits. 

OBJECTIONS TO A VEIL 

Do you consider a white veil injurious to a baby's eyes? Is it 
not better to wear none rather than a white one? 

We do not know that a white veil is much different from 
veils of other colors. We think the texture and pattern of 
more harm than the color. Except to protect from severe 
wind or from insects, we do not know why any should be 
worn at all. The child should not be placed so that the light 
glares in the eyes. 

TEACHING THE USE OF THE NURSERY CHAIR 

Who can tell me how I can teach my little girl to ask for her 
nursery chair? She is nearly two years old, and is a remark- 
ably good child. She does not talk, but understands every- 
thing we say to her, and has little ways of her own of asking 
for everything she wants, except in this one instance. 

I spank her and talk seriously to her about it, and the last time 
she cried so hard and so long that she was completely ex- 
hausted and I was really frightened; so I feel that something 
besides spanking must be done to correct the fault. I have 
been very careful to put her on the chair regularly, but I can- 
not depend upon her, and I never know when she is going to 
disgrace me in the most public places. 



400 THE CENTURY BOOK FOR MOTHERS 

Other mothers to whom I have spoken on the subject either say 
they never have had any trouble in the matter, or else they 
take it as a matter of course, and say the child will learn when 
she grows older. I think she is old enough now. 

There is no good way but to wait. It may easily— in fact, 
it constantly does— happen that a child may ask "for every- 
thing she wants," meaning every concrete thing, and yet be 
quite unable to express a want of the sort described. We 
know many young children who give warning of their need, 
but not by asking. Their watchful attendants have learned 
to associate the child's actions or expression with the cause. 
Again, one child may have ample time between the recog- 
nition of the desire for a movement and its fulfilment to 
give notice. In another child— as in some older persons- 
there is no such interval. Often we have observed children 
engaged in play who evidently were in need of attention, but 
who were so absorbed in what they were doing as to be un- 
conscious of it, until led away by the attendants. 

Nothing can be gained by spanking and frightening a child 
under the circumstances. It probably will make matters 
worse. If you are obliged to take the child into a public 
place— which of itself often excites a desire for evacuation 
of bowels or bladder— and fear an accident, see that the 
bowels are relieved by enema or suppository before you go. 

THE CARE OF FINGER-NAILS 

Can you give me some instruction as to the best method of car- 
ing for my baby's finger-nails — i.e., how to shape them in 
cutting, and how to prevent the skin from growing up over 
them? Of course it is a struggle to get them attended to at 
all, but I want to do it in the best way, if possible. 

In our judgment, the best method is to do nothing which is 
not necessary. Trim the nails as smoothly and evenly as 
possible, not too short, but short enough to prevent their 
breaking. The skin will not grow over them more than it 



PERPLEXING POINTS IN THE NURSERY ROUTINE 401 

should. The little film at the root of the nail is not harmful. 
When the child is older, if the film seems unsightly, it is 
easily removed. 

SUPPOSED ADVANTAGES OF BEING 
THE "MIDDLE CHILD" 

I have just seen the following in a newspaper: 

"Mr. George Bancroft accounted for his own longevity with 
three reasons: First, that he was the middle child in his 
father's family, equally distant from the youngest and the 
oldest; second, that he had always gone to bed at ten o'clock, 
unless it had been impossible; and, third, that he had always 
spent four hours in each day in the open air, unless prevented 
by a storm. He added that his riding, of which the newspa- 
pers had made so much, was primarily for the purpose of being 
out of doors, and not of being on horseback." 

The early-to-bed feature, as well as the out-door exercise, need 
not be regarded as new; but this is the first time I have ever 
heard of any special importance being attached to the "middle 
child," and would like very much to learn whether there is 
"anything in it." Coming from any less authority than Mr. 
Bancroft, I should have set it down as superstition and thought 
nothing further of it, though for that matter I cannot say 
that there is evidence that Mr. Bancroft really did say it, as 
the above quotation was itself quoted from another paper. 

We have never heard of the notion before ; we believe there 
is *' nothing in it" as it stands. But several facts may have 
given rise to the belief, if such belief exists. The earlier 
children of immature parents sometimes show corresponding 
feebleness of constitution, although youth of the parents, if 
they are really mature, is usually considered an advantage 
to the offspring. On the other hand, the later children, if 
many be born to the parents, not infrequently show the ef- 
fects of impaired health of the latter, particularly if the 
mother's condition is broken by constant child-bearing and in- 
cessant nursery care. Still further, the earlier children, it is 
sad to say, often show the results of the parents' want of 

26 



402 THE CENTURY BOOK FOR MOTHERS 

knowledge and bear the marks of their experiments in child- 
rearing. Not infrequently two persons of little experience in 
anything, but of the ''know-it-all" type, marry, and- the re- 
sult cannot be expected to be perfect. A lady once half 
pathetically said to the writer, when speaking of her first 
child: "The others will never know the debt they owe to 
him for teaching me." But she was a clever woman, anx- 
ious to learn. 

UNJUSTIFIED FEAR OF CONSUMPTION 

I have a bright little girl of thirteen months, who, with the 
exception of a slight attack of whooping-cough, from which 
she is now recovering, has always been strong and well. I. 
have always been very careful about her digestion, which is 
perfect. She has ten teeth, and her limbs are quite sturdy. 
She has been walking since she was eleven months old. What 
troubles me about her is that there has been consumption in 
my husband's family, his mother and a sister having died 
of it. He is himself, although well, not very robust. Should 
I take any precautionary measures in the bringing up of our 
daughter ? I believe in fresh air, and keep her outdoors on 
pleasant days as much as possible. 

Judging from all you say as to the condition of your child, 
there is no reason for worrying or taking any unusual mea- 
sures in her bringing up. Do not trouble yourself on account 
of the ancestral consumption. Do your best to keep your 
child in good condition, and do not anticipate disease of any 
kind. Of course, even a slight ailment should not be neg- 
lected ; but as she has begun so well, there is every reason to 
think that with continued care she will develop nicely. Re- 
member that consumption can come only from infection, and 
you can diminish the susceptibility to it. 

THE DEFINITION OF NERVOUSNESS 

I wish you would define the meaning of "nervousness" in the 
medical sense. 



PERPLEXING POINTS IN THE NURSERY ROUTINE 403 

When does the particular condition of restlessness which is so 
common among American children call for medical interfer- 
ence, or at least for systematic care on the part of the mother? 

I have a boy of six who is certainly excitable and not particularly 
robust. He talks in his sleep and tosses about, although he 
rarely awakes during the night. His general health, however, 
is perfect as far as I can tell. He has begun to read, and 
is exceedingly fond of his primer. Would you advise sending 
such a child to a kindergarten? Some of my acquaintances 
say it would be the very thing to quiet his restlessness, others 
say it would make him more nervous. Is there any risk in 
trying ? 

Although we find in a recent medical dictionary the follow- 
ing definition of nervousness, "excessive excitability of the 
nervous system, especially as manifested by a proneness to 
mental excitement and over-sensitiveness to sensory impres- 
sions: the condition sometimes borders on hysteria or in- 
sanity," yet we think we are justified in saying that the 
word is a popular rather than a medical one. It is not much 
used by medical men when speaking with precision, other 
and more exact terms being used to describe various mani- 
festations of this instability of the nervous system. When 
used in the general sense quoted above, its application is 
wide, reaching all the way from the high-strung person who 
is really susceptible, ordinarily well, self-controlled, and 
capable of superb exertion on need, to the common fidgety 
person, the pest of his associates. The former would, per- 
haps, be called by the physician a neurotic subject, the latter 
very probably a hysterical one. So you see we cannot give 
you categorically the answer you desire. 

We are not sure that we can assent to the statement that 
a particular condition of restlessness is very common among 
Americans as distinguished from others. But it would take 
us too far to discuss this point now. We should answer 
your question thus: If a child manifests a restlessness which 
seems to the parent excessive, the advice of a good physician 
should be sought. By good physician, in this sense, we mean 



404 THE CENTURY BOOK FOE MOTHERS 

one of some experience with children's diseases and their 
developmental peculiarities, who can judge wisely whether 
the restlessness be probably dependent upon bad hygiene, such 
as improper food, bad sleeping arrangements, constipation, 
or is due to some local source of irritation, of which defects 
of vision, skin diseases, pin-worms, and phimosis are exam- 
ples, or again to simple imperfect nutrition in some of its 
many forms. The object of his search will be to assure him- 
self whether or not any such causes can be found. If so, 
he will try to find the best remedy ; if not, he will advise about 
domestic care and training, which are, after all, usually the 
most needed. 

As to your own child, supposing that you are correct in 
considering his general health perfect, and assuming that 
this nocturnal restlessness is of recent appearance, the first 
thing we should think of would be the irritation of the ''six- 
year-old molars," which may be coming. Next, we should 
inquire into his dietary, and especially as to his evening meal, 
and should examine as to the existence of phimosis. In any 
event, we do not think that a well-conducted kindergarten 
could do him harm, and, if the nervousness is not excited 
by any recognizable and removable cause, it would probably 
be of advantage to him. 

WASHING THE INFANT'S MOUTH 

Should an infant's mouth be washed before he is six weeks old? 
I heard of a case where the child's mouth was not washed from 
the time of birth, and I thought it conducive to thrush, sprue, 
or a soreness of the mouth. 

It is best to wash the mouth after every nursing or feeding 
from the first, especially if the bottle is used. 

THE GIVING OF AN ENEMA 

What is the best way of giving an enema to a child? How 
much fluid should be given to a child of six weeks, and how 



PERPLEXING POINTS IN THE NURSERY ROUTINE 405 

much to one of two years? Should oil, salt, or soap be used 
in all cases? What is the best syringe for children? How 
much oil should be used in proportion to the water? How 
long should the fluid be retained before the child is put on 
the chair? Any general directions about the giving of an 
enema will be greatly appreciated. 

The best syringe for children is one of hard rubber, with a 
long, smooth nozzle, and having a capacity of six fluid ounces. 
When oil alone is injected, a relatively small quantity is 
used, and the intention is to have it remain in the intestines 
and act mechanically on the feces; its retention is best se- 
cured by firmly pressing a warmed pad of flannel against 
the seat for five minutes after the insertion, the child in 
the meanwhile lying upon its back. An enema of water 
may be presently used if necessary. The laxative enemata 
must vary in bulk with the age of the child, or, in other 
words, with the capacity of the rectum. One fluid ounce 
(two tablespoonfuls) will be sufficient for an infant of six 
weeks, while from four to six fluid ounces are required at 
the age of two years. The quantity of oil, salt, or soap to 
be used must depend upon the quantity of water— two tea- 
spoonfuls of oil or one teaspoonful of salt to eight table- 
spoonfuls of water being a good proportion, and if soap be 
employed it is sufficient to stir a bit in the water until suds 
begin to form. After drawing the fluid, which must be 
tepid, into the syringe, the nozzle must be well greased and 
gently inserted into the seat, the point being directed a little 
toward the child's left ; next, the piston is to be slowly forced 
down until all the liquid is expelled or complaints of pain 
indicate that the bowel is sufficiently distended. If it be 
possible to force retention for a moment or two by pres- 
sure on the seat, the movement will be freer and easier 
than if the fluid be allowed to flow away at once. The 
best position for the child is either on his back with the 
legs well drawn up or resting on his abdomen across 
the lap. 



406 THE CENTURY BOOK FOR MOTHERS 

THE MUSTARD-PLASTER 

Can you tell me how to prepare a mustard-plaster for a child? 
How long should it be allowed to remain on the skin? Can 
the plaster be put next to the skin? Is mustard-paper of any 
value ? 

A mustard-plaster for a child should be made of white in 
preference to black mustard, as the latter has nearly twice 
the strength of the former. For a patient between one and 
three years old, one part mustard and two parts Indian-meal 
or flour are to be mixed with lukewarm water— care being 
taken not to make it too thin— and spread between two folds 
of thin muslin, as a poultice is spread, only in a very much 
thinner layer. This may be allowed to remain on for from 
fifteen to thirty minutes, or until the skin is reddened or the 
child complains of its burning. Under one year the propor- 
tions should be one of mustard to three or four of flour, and 
for children of over three years equal parts may be used. 
Never apply the mustard directly to the skin, as some of it 
may escape being washed off and give rise to a blister. Mus- 
tard-paper consists of black mustard mixed with a solution 
of gutta-percha and spread on pieces of stiff paper about 
four inches square, which, when moistened, are ready for 
use. These sinapisms are very convenient for travelers, but 
their action is often rather severe, and they are not to be 
recommended for children. 

If a child is very young or unconscious, the plaster should 
be carefully watched, for fear of too great irritation of the 
skin, a mustard blister making a very intractable sore. 

KISSING BY FORCE 

I believe it is high time for mothers to organize an anti-kissing 
club, at least so far as their babies are concerned. The mat- 
ter is brought home to me almost daily, owing to the fact that 
I have what one fond relative calls the most "kissable" baby 
in town. The poor child is kissed and hugged almost to death. 



PERPLEXING POINTS IN THE NURSERY ROUTINE 407 

certainly to the point of nervous restlessness. And then, it 
seems to me there is the danger of communicating some throat 
trouble. But one of my friends thinks that children ought to 
be trained early to be friendly, and that it is not wise to keep 
them away from fond visitors. I wish you would publish 
some remarks on the subject, so that I may reinforce my pro- 
test by the weight of your authority. 

The promiscuous kissing of children is certainly to be depre- 
cated on various grounds. Many persons, in their affection- 
ate zeal to kiss a child, do not stop to consider whether they 
are themselves pleasant persons to kiss, and older children 
often feel a strong sense of resentment when kissed against 
their will. The contagious disorders of mouth and throat 
can be, and probably often are, communicated in this way. 
They certainly are in adults. The breath of persons suffer- 
ing from whooping-cough, measles, and scarlatina is univer- 
sally dreaded ; but, excepting the first named, and more 
rarely in the first stages of the others, owing to the isolation 
of the patients, these diseases are probably not often spread in 
this way. The danger, we believe, is especially great in 
connection with the various kinds of sore throat, and no one 
with a sore throat, however slight, should kiss a child. But 
even a well person should consider whether his affection for 
a pretty child ought to be expressed in a way which may be 
distasteful to the child and not approved of by the mother. It 
is easy enough to show our tenderness by some caress which 
cannot harm. Certainly no child ought to be made to kiss 
any one against its will. Proverbially, ''kissing goes by 
favor," and it is foolish to make an act which is universally 
accepted as an expression of hearty good will seem to a child 
disciplinary. 



XXV 
FEEDING PROBLEMS 

THE SELECTION OF A WET-NURSE 

The evils and dangers of intrusting one's delicate child to a 
stranger are no doubt great; but, after all, in many cases th3y 
must be bravely met in order to save the very life of the child. 
Artificial nourishment is at best only a makeshift. I tried it 
once, in the case of my second child, but determined never to 
bring up another child on the bottle as long as I was able to 
pay for a wet-nurse and bear up physically under the inevitable 
annoyances in her train. But not many mothers can bespeak 
a wet-nurse in advance, and in the hurry of procuring one in 
the hour of need it is almost impossible to exercise the care 
and discretion that are so essential in the selection of the 
proper person. Nor is a physician's advice always available. 
I have often wished to be informed concerning the physical 
qualifications of a wet-nurse, but have never found anything 
really useful in popular books or periodicals. It would seem 
superfluous to look for even average mental or moral quali- 
fications in persons of the class that furnishes wet-nurses, and 
I know that many excellent persons object to employing them 
under any circumstances whatever. But those who do em- 
ploy them need enlightenment. Perhaps you could furnish 
what I have vainly looked for elsewhere. 

Before speaking of the qualifications of a wet-nurse, a word 
ought to be said as to the duty of the mother who is obliged 
to give up the suckling of her own child. It has been in 
effect said by another that any one who takes the responsi- 

408 



FEEDING PROBLEMS 409 

bility of bearing a child is bound to furnish its food from 
her own breast, or to superintend herself the feeding of it if 
she cannot nurse it. Exceptions will occur, as when the 
mother's health absolutely disables her; but the rule will 
stand. It would seem as if this would need no insistence, 
but it is a matter of daily observation that there are many 
mothers who will hardly trust the house-maid to dust the 
bric-a-brac, who insist on personally laying out the changes 
of bed-linen and dispensing the groceries, and yet who never 
think of inspecting, except perhaps at rare intervals, the 
method in which the baby's food is prepared. Further, it is 
proper to say that good artificial feeding is scarcely any more 
a makeshift than most wet-nursing. 

Now, if a wet-nurse is procured a similar supervision 
should be exercised as over the dry-nurse. As wet-nurses 
are not selected from the highly intelligent classes, it is not 
to be expected that, without experience, they will be very 
handy and tactful with a baby ; and an experienced wet-nurse 
is not usually desirable, inasmuch as young women have, as 
a rule, the best breasts, and experience and youth do not 
go together. The mother must do the watching, and remem- 
ber that the nurse has been chosen for the one physical 
quality of a good breast of milk. If she is not handy with 
the baby she is usually very glad to learn if she is kindly 
taught. 

A common complaint is that wet-nurses are tyrannical, 
demanding stimulants and various luxuries for the sake of 
the milk, and threatening to desert the baby if their de- 
mands are not granted. Occasionally a distinctly vicious 
woman goes out as a wet-nurse, but as a rule they are nei- 
ther better nor worse than other women in their rank of life, 
and come with an honest intent to do their duty. On the 
whole, they are amenable to intelligent treatment. If they 
prove to be tyrants it is because of want of sense on the part 
of their employers. In engaging a wet-nurse, she should be 
made to feel, if possible, that she has an interest in common 
with her employer; that the employer is desirous of doing 



410 



THE CENTUEY BOOK FOR MOTHERS 



what is best for her health and comfort, because by so doing 
the welfare of the child is best secured. Moreover, she 
should understand that it is for her interest faithfully to 
attend to her duties ; that no trifling with her own digestion 
and health will be tolerated; and that, while she will be 
valued in proportion as the child thrives, she will not be 
kept for a day if she neglects its interests. Let her under- 
stand that, while you desire breast milk if it is good, you 
much prefer artificial feeding to poor breast milk. If these 
things are clearly and kindly impressed upon her there is 
little probability of her playing false. The other method, 
too often seen, is to make a sort of pet of the wet-nurse for a 
while, to foolishly coddle her in all ways, until she is per- 
suaded that she is indispensable; and then, unless she is a 
person of unusual judgment, she is spoiled, and the employer 
reaps the harvest of her own folly, and considers the nurse a 
most ungrateful, if not an inhuman, creature. 

The choice of a wet-nurse should not be made without a 
careful medical examination ; the risk is too great. The em- 
ployer may ascertain points as to the character of the nurse, 
and may perhaps get information regarding her previous 
health and the health of her child or children. But, after 
all, the burden of the examination is medical, and cannot be 
properly assumed without professional knowledge. And for 
the physician it is an unenviable office. Not only must he 
find out the condition of the breast and the supply of milk 
and its probable continuance, but he must search with the 
greatest care for diseases or defects. And in this search he 
is never helped by the person examined; she usually has no 
knowledge of the meaning of symptoms, and she lays no 
stress upon many things which the examiner would consider 
fatal objections. If she has knowledge of defects, in her de- 
sire for employment she would not obtrude them. The de- 
tails of the medical examination it would be useless to give 
here. The physician also endeavors to distinguish between 
the appearances due to ill health and those due to poverty, 
want, and perhaps even hunger, or to distress at the pros- 



FEEDING PROBLEMS 411 

pect before the nurse of leaving her own child, for which 
she— and often with oood reason— fears the worst. 



CAN THE NURSE'S OR MOTHER'S MILK 
BE POISONOUS? 

I read once of nurse's milk (I suppose it means mother's, too) 
sometimes being too "poor, or so poisonous as to be useless." 
I wish to learn the cause or causes of this, and how one can 
know it, so as not to injure the infant. 

The milk of a nurse or mother is rarely poisonous in the sense 
of producing any sudden illness. Rare cases of such effects 
have been reported in which the change in the milk followed 
fright, anger, or some violent emotion on the part of the 
mother or nurse. Milk usually disagrees by causing bowel 
troubles, or more commonly by being too poor in quality, so 
that the child is not properly nourished, and after a while 
shows that it is not. Unfortunately, in this last, and the 
commonest, class of cases there is no sure way of judging, 
except by constant observation of the child to see if it is 
thriving — i. e., gaining weight, however slowly, keeping its 
firmness of flesh, its color, etc. 

THE FLOW OF MILK THE FIRST DAYS 
AFTER DELIVERY 

Will you please tell what is best to be done on the two dreadful 
days after birth, "before the milk comes"? If there is to be 
none, would it not be as well to feed the child at once? Why 
is there such a break in an infant's nourishment? 

Those days are not always "dreadful"; indeed, we think 
they rarely are so in this day of good nursing. That the ab- 
sence of the milk is not a detriment to the baby may be in- 
ferred from the fact that most living things in nature are 
adapted to their surroundings, and also from the following 
facts: Not only infants ])ut all young mammals pause in 



412 THE CENTURY BOOK FOR MOTHERS 

their growth for a few days, perhaps for a week, after their 
birth, and they may absolutely lose weight. A similar delay 
is noticed in newly hatched chickens, which, of course, never 
depend upon the mother for food. The experiment has been 
tried, in a series of cases, of putting new-born infants to 
the breasts of women who had been delivered a few days 
previously and whose flow of milk was established. These 
children all lost weight like others. The cause of this loss is 
not certainly known, but is believed to be due to the fact of 
the establishment of respiration and the necessity of the 
child's furnishing its own heat instead of getting it from its 
mother. More tissue is burned up until the new order is 
established. Besides, the intestinal canal is emptied of a con- 
siderable amount of gradually accumulated matter. If dur- 
ing those days the child is kept warm and its thirst quenched 
with warm liquid, it generally makes little complaint. 



GOAT'S MILK AND ASS'S MILK 

Are goat's milk and ass's milk ever prescribed for children? 
How does such milk differ from cow's milk? 



Both have been given, but rarely in this country. Goat's 
milk is fatter than cow's milk. Its smell is disagreeable to 
many, and it has no advantages over cow's milk. The milk 
of the ass has less fat and proteids and more sugar than cow 's 
milk, and is in these, as well as in some other peculiarities, 
intermediate between cow's milk and human milk. It has 
been considerably used upon the Continent. Mare's milk is 
much like ass's milk. 



TESTING THE QUALITY OF BREAST MILK 

How rich should breast milk be? That is, if drawn and placed 
in a bottle to the depth of two inches, how much should the 
cream measure? 



FEEDING PROBLEMS 413 

If you let it stand in a room of ordinary temperature twen- 
ty-four hours the cream should be on an average nearly one 
eighth of the whole, say a quarter of an inch in tAvo inches. 
Variation between one tenth and one fifth may exist in milk 
upon which the mother's infant thrives, but the average is as 
stated. A test tube with a rubber cork, which may be ob- 
tained at the apothecary's shop, is a more convenient appara- 
tus than a bottle for testing. But this testing by eye must 
not be considered as absolute. 



OBJECTIONS TO GIVING BREAST MILK BY SPOON 

I would like your opinion on the practice of drawing mother's 
milk at one nursing, and feeding it to the baby by spoon or 
bottle for the next. Is it as good for the baby? And does it 
remain unchanged by standing and being warmed? 



For various reasons, it is not a good plan. Not to mention 
other objections, the milk is no longer the sterile liquid which 
it probably was, or nearly so, when it came from the breast. 



BOTTLE VERSUS SPOON 

Do you think that a little baby could be fed as satisfactorily by 
spoon as by bottle once a day? I dislike bottles, and never 
used one when I weaned my first baby at ten months, but do 
not know whether a spoon would be too fatiguing for a three- 
months' baby. 

We prefer the bottle if kept clean. The only circum- 
stances under which we prefer the cup and spoon are when 
we think the attendant will keep them clean and cannot 
be made to keep a bottle and nipple clean. A child of 
ten months is no longer "a little baby" as nurses use the 
phrase. 



414 THE CENTURY BOOK FOR MOTHERS 



"SUCKING WIND" 

Is it possible for a baby to "suck wind" into its stomach from a 
nursing-bottle? I had always accepted it as an unquestioned 
fact until, in a recent number of a periodical, I noticed that 
the idea was ridiculed. Nurses and m.others might be re- 
lieved of considerable anxiety in this matter if it could be 
shown that "sucking wind" is only an "old-woman's whim," 
as alleged by the writer of that article. 

There is nothing ridiculous in the supposition that a child 
may "suck wind" from a nursing-bottle improperly man- 
aged. Cases of air-swallowing by adults are cited in works 
on medicine. The celebrated French physiologist Magendie 
made extended researches on this point. He found that 
many persons had the power of swallowing air, and he 
learned to do it himself, but gave up the practice owing to 
the distress it caused him. ''Wind-sucking" is a familiar 
enough vice in horses. There is, therefore, nothing ridicu- 
lous in supposing that a baby with good sucking power might 
swallow air. How far infants actually do so is another mat- 
ter; the distinction between a colic from swallowing of air 
and one from gaseous indigestion can be made only after 
patient watching of the symptoms. The rule should be: 
Manage the bottle so that the baby cannot get air from it. 



COMBINED NURSING AND BOTTLE-FEEDING 
AT ONE MEAL 

Do you think nursing and bottle-feeding together at the same 
meal bad for a baby ? 

We do not like it, not so much because of the mixing of the 
two kinds of nourishment, as because, if the breast is not 
equal to the total feeding, it ought to have the needed rest. 
Further, the child contracts a bad habit of wanting the breast 



FEEDING PEOBLEMS 415 

with artificial food, and weaning becomes difficult. Still 
further, it is impossible to know just how much a child is 
taking when this confused method is employed. 



THE SIGNS OF INSUFFICIENT BREAST MILK 

I have so frequently seen it stated that few mothers have breast 
milk of sufficient quantity and quality for a baby of eleven or 
twelve months, that I should like to inquire what are the in- 
dications that a baby needs more nourishment than the breast, 
and whether you approve of changing to artificial food by de- 
grees, giving one bottle a day for a month or two, perhaps, and 
slowly adding more. I have been taught that a baby during 
the first months of its life should gain one half-pound a week 
in weight. How long should this gain keep up, and does a 
sudden lessening of the gain indicate that the breast is not sat- 
isfying, and what other food is required'^ 

The signs that the milk of a breast is no longer equal (either 
in quantity or quality, or in both) to the needs of the child 
are a diminution of increase in weight, softness of flesh, pale- 
ness, clamor for more prolonged or more frequent sucklings, 
and the like. During the early months a gain of half a 
pound a week may be accepted as evidence of decidedly good 
nutrition, provided the flesh be firm and the color good. 
After five or six months as much as this can hardly be ex- 
pected. The gain will be less and vary somewhat. But a 
sudden, material lessening of the rate of gain should always 
be looked upon with suspicion, and if it persists more than a 
week or two the condition of the breast should be investi- 
gated, and usually a need of additional food will be discov- 
ered. We approve of the gradual method of increasing the 
food, provided it appears that the breast is still valuable to 
a considerable degree. Often it proves of so little value that 
rapid substitution of artificial food is necessary, the breast 
serving only to amuse or quiet the child at night. 



416 THE CENTURY BOOK FOR MOTHERS 

NURSING ANOTHER BABY IN ADDITION TO ONE'S OWN 

Is there any harm in nursing a baby four months old (with 
whom no food agrees, its own mother having no milk) when 
one's own baby is but a few days old? Is the difference in 
ages too great, and will the young baby suffer? If there is 
harm in so doing, please state how. 

As a rule, the new breast agrees i)erfectly well with the older 
child, unless it has some form of digestive trouble which 
forbids the use of any kind of milk. On the other hand, we 
do not know whether the new babe is to get enough from the 
breast. The new one ought certainly to have the first chance, 
and the visitor should come in for what is left. Besides, 
extra care of the nipples is necessary when one suckles a baby 
who is not well, and care of the mouth of the sick baby is 
also necessary. The disadvantages in the case seem to be on 
the side of the new baby, who is the proper owner of the 
breast. 

THE SUPPLY OF BREAST MILK AS COMPARED WITH 
THE ALLOWANCE OF BOTTLE-FED BABIES 

How many ounces of milk should a six-months-old baby be 
allowed to have at a feeding? I have been told six ounces, but 
as that never seems to satisfy her, I have been giving her be- 
tween seven and eight. She has seven meals in twenty-four 
hours. Breast-fed babies nurse till they are satisfied; why 
not let bottle babies do the same? Why are they limited to a 
certain number of ounces while breast babies have an un- 
limited supply? 

The amount at six months varies a little with different babies. 
Six would be an average demand, seven a large amount. 
But only six meals are proposed on this basis. Your child 
at six months is getting between seven and eight ounces seven 
times a day; that is between forty-nine and fifty-six ounces 
daily— a pretty heavy allowance of food, even if properly 




FEEDING PROBLEMS 417 

diluted, for a child of one year. You say ' ' of milk, ' ' but we 
assume that you mean diluted milk. 

Your assumptions about nursing babies are wrong. If 
you were to weigh one before and after nursing, you would 
find that almost never does one get as much liquid as your 
child gets. The breast milk is far from "an unlimited sup- 
ply." The amount recommended for artificial feeding is 
based upon accurate observations of nursing babies. Why 
your baby is not satisfied we do not know. Very possibly 
from an over-distension of the stomach and overtaxing of 
digestion. 

EVILS OF EARLY MIXED FEEDING; EFFECT OF THE 
MOTHER'S DIET UPON THE CHILD'S TEETHING 

Should a child from three to five months old be fed at all at the 
table when there is a sufficiency of mother's milk? If so, what 
should it be given? My babe, now five months old, seems to 
delight in eating, and, as I think I have enough milk for her, I 
hesitate in giving her solid foods, though I am advised to feed 
her by ladies who feed and also nurse their babies with no ap- 
parently bad results. My baby is troubled with constipation 
and I am told that feeding her will overcome it. 

Is it right and proper to "chew" food for babies? 

Cannot a mother that suckles her babe hasten or retard its 
teething by selecting her diet; i. e., if early development of 
teeth is wanted, partake of bone-making foods, and vice versa? 

A child should have nothing whatever from the adult table 
before a year and a half at the earliest, preferably hot until 
two years. Solid food should not be allowed until after a 
year, and then it should be bread, gruels, porridge, and pos- 
sibly an egg; but these should be prepared for it and given 
it by itself, not at the adults' table. To let a child come to 
the table is only to teach it to beg for things it should not 
have. Let it be fed before your meals, so that it shall not 
be tantalized at seeing you eat when it is hungry. Treat any 
person who gives your baby ''tastes" of things as your 

27 



418 THE CENTURY BOOK FOR MOTHERS 

''dearest foe." To give solid food to a child on the breast 
is too incongruous to be seriously considered. Constipation 
is undesirable, but a small matter compared with what usu- 
ally results from such mixed feeding. 

If you mean the chewing of food by an adult and then 
putting it into the baby's mouth, it certainly is not right. 
It is simply disgusting. 

Good health and good milk-supply in the mother help to 
develop the child well and rapidly, teeth included. But so 
far as we know or believe, there is no diet of the mother 
which will help the teeth of the child in particular. The 
only way of retarding the teeth that we know of is to give the 
baby poor nourishment, and this retards its development in 
every other way. 

FEEDING AT NIGHT AFTER WEANING 

My boy is now nine months old, and gets all his nourishment 
from the breast. I am very particular about my diet, eat oat- 
meal, milk, eggs, fruit, etc. He is nursed once in three hours, 
night and day. Shall I feed him in the night, after he is 
weaned, and if so, how often ? 

If you have not diminished the frequency of nursing before 
you begin to wean the boy, you will have quite an under- 
taking before you; for if you have to prepare food every 
three hours, night and day, your sleep will be badly broken. 
It may be, however, that his frequent demands for food are 
due to the fact that the breast milk is now deficient in quan- 
tity or quality, so that he is not properly fed, and if he gets 
a full supply of food at one time he may be content for a 
longer time. Try to alternate the food with the breast; let 
him take a good bottleful of the food, and then lengthen the 
interval after it. We fear that your habit of too frequent 
nursing will prevent your cutting him off altogether at night 
at first, but a child as old as he ought to go at least six hours 
without food at night. If he is fed at the parents' bedtime 
he ought to need no food till toward morning. 



FEEDING PROBLEMS 419 



THE TESTS OF RICH MILK 

I live in a part of the country which is noted for the excellence 
of its milk-supply, yet I have my doubts about the quality of 
the particular milk which is furnished me. It somehow has 
not the rich flavor to which I am accustomed, and looks rather 
thin. My purveyor is a well-to-do farmer, who supplies me 
with the choicest vegetables, and I don't like to suspect his hon- 
esty as to the milk without good cause. Is there any way by 
which one can positively tell whether milk is skimmed or not? 

You can set some of the milk to raise the cream in a straight- 
sided test-tube, and guess by eye the percentage of cream. 
Or you can get an ordinary druggist's graduated glass, or 
even one of the bottles in Avhich milk is sold, upon which a 
mark is blown to indicate the point to which the cream after 
rising should reach down. This will not positively tell you 
whether or not the milk has been skimmed, but it will tell 
you Avhether or not it still contains cream of the standard 
amount. 

SCUM ON BOILED MILK 

Will you tell me what part of the milk rises to form the scum 
on the top when boiled, and whether it should be removed or 
stirred in before feeding to a child? 

We do not remember to have ever seen a chemical analysis 
of this scum, but suppose that it is chiefly the milk albumen, 
and probably some fat mechanically mixed with it by the 
boiling. Whether it is to be rejected or not is a question of 
palate. Personally, we throw it out. 



A WARNING AGAINST SOUR MILK 

Can you tell me what to do when the milk sours with which I 
have to feed my eight-months-old child? My milkman comes 
at night, and on one or two occasions the milk has been sour at 
the two-o'clock meal the next day. What can I give my child 



420 THE CENTURY BOOK FOR MOTHERS 

as a substitute when this occurs? It troubles me when I 
try to think of what I should do in case of not having any 
milk. 
The milk I get is usually very good, and the man who brings it 
says the souring is caused by some cows going dry. Ought 
such milk to be used? 

Under no circumstances should sour milk be given. During 
hot weather it is better to attend to the preparing of food 
and sterilizing of milk as soon as the latter is received. In 
case of milk souring, if sweet milk cannot be had, we should 
use condensed milk, or even water gruel, for the day, rather 
than give any doubtful milk. 



DANGERS FROM IMPURE MILK; WHEN STERILIZATION 
IS NECESSARY 

Is sterilization of milk necessary in the country for a child of 
fourteen months? What, specifically, are the microbes to be 
feared from non-sterilization? I mean, are they germs of 
known diseases? What particular harm is done by spoiled 
milk? 

It can be told only by the results. If the consumer of the 
milk escapes disease it Avas not necessary to sterilize. But 
we would say that it is probable that if you control your 
milk-supply— including care of cow, its stabling, care of the 
milk and all— you are safe. The amount of simple filth 
which is separated from ordinary milk by the centrifugal 
separator is appalling. The germs of known diseases which 
may, and not so very rarely do, infect milk are those of tuber- 
culosis, scarlatina, and typhoid fever. Other diseases are 
less frequently conveyed by milk. In addition, there is a 
good deal of harm done by the bacteria which cause the ordi- 
nary spoiling of milk, and which set up bowel troubles ; and 
—rarely, it is true— the terrible poison tyrotoxicon causes a 
vicious choleraic disorder. 



FEEDING PROBLEMS 421 



KEEPING STERILIZED MILK IN SUMMER 

Will you tell me whether you think it necessary to keep steril- 
ized milk on ice during the warm weather? Our summers 
are quite severe at times, the thermometer registering from 
80° to 95° in the house. I have never used the sterilized milk 
before in the warm season, and so I am ignorant as to what I 
should do. At present I keep the bottles in as cool and breezy 
a window as I can find. The milk is thoroughly sterilized, 
boiling hard forty-five minutes, and has never yet disagreed 
with my nine-months-old baby, who has taken it almost since 
birth. 

Milk which is thoroughly sterilized and thoroughly well 
corked need not be iced. In fact, so far as its sterility goes, 
it ought to stand anything so long as the bottles are tight. 
When milk is only partially sterilized or imperfectly corked, 
or in any way neglected in the preparation, of course this 
remark will not hold. In every case of doubt the bottles 
should be iced. 

DOES STERILIZED MILK CONSTIPATE? 

Are there not cases where sterilized milk will produce consti- 
pation? 

Yes, practically. That is to say, the milk, having been ren- 
dered unirritating by sterilization, no longer stimulates the 
bowels to the degree that raw milk does, and is constipating 
in the same sense that white bread is constipating as com- 
pared with coarse bread. To speak more accurately, we 
should say that sterilized milk was not laxative as compared 
with uncooked milk; and so some infants using the sterilized 
become, temporarily at least, more constipated than before. 

INJURIOUS QUALITY OF LIME-WATER 

Will you kindly give me the proportion of lime-water to be used 
in a seven-ounce bottle of sterilized milk? Some physicians 



422 THE CENTURY BOOK FOR MOTHERS 

say a tablespoonful, others say that amount is very injurious 
for a child nine months of age, and that a teaspoonful is all 
that should be used. If a tablespoonful is given, what bad 
results would follow its use? 

The amount varies with conditions. Thus, if a child were 
ill, we might use more than we would in health. Again, it 
varies with the milk. The object of the lime-water is to 
change the reaction of the milk mixture so that it shall re- 
semble that of breast milk. Thus, breast milk is usually 
slightly alkaline. Cow 's milk, as milked, is neutral or slightly 
acid; as sold, usually distinctly acid. We are speaking of 
chemical reaction as shown by litmus paper, not by taste. 

In making a food mixture we usually add lime-water after 
sterilization until the mixture is slightly alkaline. A seven- 
ounce mixture will usually be made alkaline by five per cent, 
of lime-water, say two and a half or three teaspoonfuls. But 
if the '* sterilized milk" be undiluted milk, then, probably, 
more lime-water would be needed. We do not think that a 
tablespoonful would produce any distinctly bad results, but 
if a less amount of alkali will produce the result it is better 
in health to use less. 

Litmus paper is cheap ; it can be bought of a druggist, who 
will show you how to use it. It should be cut into very slen- 
der slips and kept in a tightly corked vial. 

FOOD VERSUS SLEEP 

My baby, four weeks old, will sleep three, four, and five hours at 
a time. Should he be awakened to feed him? He has never 
had any kind of soothing syrup. 

He certainly need not be awakened at night. By day the 
feeding will need to be attended to rather more frequently, 
if regular habits are to be established. The child need not 
be rudely awakened, but when the time for his food arrives, 
the bottle can be prepared, the nipple put into his mouth, 
and the child gently aroused sufficiently to take the food. 



FEEDING PROBLEMS 423 



THE PREPARATION OF BARLEY-WATER; ADVISABILITY 

OF STERILIZATION; QUANTITY OF MILK AND 

BARLEY-WATER FOR A ONE-YEAR-OLD 

I shall not wean my baby of ten months and a half for another 
month or two, but would like to know whether you would ad- 
vise sterilized milk or the top-milk plan. If the latter, will 
you kindly give directions how to prepare the same, also how 
to prepare barley-water to use with sterilized milk? I must 
depend upon a milkman for the milk, and thought on that 
account the sterilized would be better than the top-milk. I 
nurse my boy every three hours during the day. He weighs 
twenty-two pounds and has four teeth. 

How much milk, or milk and barley-water, should he take in 
twenty-four hours ? 

For a child of a year it is not necessary to prepare milk as 
for a young infant. Milk diluted with barley-Avater will do 
well enough. The milk may be sterilized if there is any 
doubt of its perfect purity and sweetness, or if there is doubt 
as to its keeping. Sterilization is not an attenuation of top- 
milk or any other mixture. Any mixture may be sterilized 
if desired. It is a method of preserving, not of mixing. 

A good receipt for barley-water is this : Three tablespoon- 
fuls of pearl barley, three cupfuls of boiling water, and just 
enough salt to take oif the "flat" taste. 

Pick over and wash the barley carefully. Cover with cold 
water and soak four hours. Put the boiling water into a 
farina kettle, stir in the barley without draining, and cook, 
covered, for an hour and a half. Strain through coarse mus- 
lin, salt and sweeten slightly, and give when it is cool enough 
to be drunk with comfort. He will take, if he has an average 
appetite, three pints of milk and barley-water at a year old, 
and will probably take more soon. The mixture at the begin- 
ning may be half-and-half, but presently gradually increase 
the proportion of milk. 



424 THE CENTURY BOOK FOR MOTHERS 

THE VALUE OF BARLEY AND OATMEAL GRUEL 

Is not barley gruel with milk more constipating than milk diluted 

with water? 
Why is it considered better to use barley gruel or oatmeal gruel 

with the cow's milk for a child with weak digestion ? 

Barley gruel does not, in our judgment, increase the consti- 
pating effect, but it is less laxative than oatmeal gruel. 

The salts contained in the gruels are useful, and many 
believe (while some disbelieve) that the gruels favor the for- 
mation of a finer and more digestible curd of milk on the 
stomach. 



HARMFULNESS OF NEW BREAD AND COOKIES 

Will you please say a convincing word to mothers against the 
use of new bread and cookies for the little ones? I know many 
a mother, so careful lest her child get wet or "take cold," who 
yet destroys digestion by the use of these two articles of diet; 
and by no means is it the uneducated mother alone who thinks, 
as one said to me, that "fresh bread is good enough for any 
one." I suppose that new bread and pies, more than climate 
or work, have made us the nation of dyspeptics that we are. 

We doubt if we can say a ' ' convincing Avord, ' ' for we believe 
the habit of giving children such things comes not from 
ignorance, but from that lazy amiability which prefers to 
gratify them at the moment rather than to deny them any- 
thing at the cost of some self-denial and perhaps transient 
trouble. We can hardly imagine that intelligent persons 
really suppose these things good for children, but they sim- 
ply follow their natural bent and deny the harmfulness of 
any course they like to pursue. 

THE RELATIVE MERITS OF GRAHAM AND WHITE BREAD 

Please inform me as to the relative merits of Graham and white 
bread for a child sixteen months old? 



FEEDING PROBLEMS 425 

The theoretical Graham flour is unbolted and contains the 
bran. Practically, if we mistake not, this is not entirely true. 
Graham bread, as sold in the shops, seems to be made of 
something like half Graham and half white flour. Assum- 
ing, however, that you have a real unbolted wheat flour— 
and Ave ought first to premise as regards all we here say that 
the child has its first molars, or chewing teeth— the differ- 
ences would be about as follows : The wheat bread would be 
a trifle the more digestible if both were equally Avell made 
and equally stale—/. (?., not fresh. The Graham would be 
the more nutritious if digested. The Graham would also be 
rather more laxative, especiall}^ if it be made, as is usual, 
with the addition of a little molasses. IMuch would depend 
upon individual digestive ability. If Graham bread were 
given its effect should be noted. 

BALLS FROM GRAHAM FLOUR 

Could not flour-balls be made from whole-wheat flour, or rather 
from sifted Graham, which would be more laxative and more 
nutritious than if made from white flour ? We buy the whole 
wheat and have it ground fine, and use a great deal of it in 
the familj'. 

They could be made from those flours, but, as the composi- 
tion of the white flour is changed by the prolonged boiling, 
similar changes will take place in the Graham flour, and if 
that part only which will pass through a sieve is to be used, 
the result would probably be almost identical with the ordi- 
nary flour-ball. There is, however, no harm in trying it. 

GRAHAM, OATMEAL, AND THE VARIOUS 
PREPARED CEREALS 

^\^lat do you consider the most wholesome flour of which to make 
bread? What is Graham flour, and what is its value as a food, 
actual and as compared with other flours? 

What do you think of oatmeal as an article of food? What is 



426 THE CENTURY BOOK FOR MOTHERS 

the most nutritious and palatable preparation of any grain 
known to you in a form suitable for use, say, on the breakfast- 
table. 

All things considered, we should regard a very finely ground 
wheat-meal the best for bread for ' ' the average man, ' ' Theo- 
retically, Graham flour is such a meal; practically, we are 
inclined to think some parts are removed. As made at bak- 
eries, Graham bread contains bolted flour to dilute the Gra- 
ham flour. If made at home it becomes a very wholesome 
and, to many persons, palatable bread. White flour has lost 
much of the nutrient part of the grain and is very largely 
starch. Some persons— those of the "gouty diathesis," for 
instance— are injuriously affected by a starchy diet; for such, 
white bread is not very wholesome. 

Oatmeal is very nutritious and, if well cooked, an excellent 
article of food. In our judgment, however, many persons 
more than offset its nutritive value by injurious amounts of 
syrup or sugar eaten upon it. With salt and milk, or cream, 
it is to most stomachs digestible and, to our taste, delicious. 
Meal of poor quality or badly cooked is detestable. Oatmeal 
and the various forms of cracked or crushed wheat— the trade 
names are legion— which retain the entire grain, are the 
most nutritious of grain foods for the breakfast-table. The 
palatability must be judged by the eater. Occasionally oat- 
meal disagrees, being popularly said to be ''heating," par- 
ticularly to persons with a tendency to eruptions. 



HONEY AND MOLASSES 

What is your opinion of honey and the ordinary brands of mo- 
lasses as a part of the dietary of children? 

Honey is a mixture of several sugars and of other things. 
For some reason it often disagrees, and persons of good di- 
gestive power not infrequently suffer violent attacks of indi- 
gestion from it. If it agrees it may be used under the same 



FEEDING PROBLEMS 427 

restrictions as other sweets. Concerning molasses as an ar- 
ticle of food, our opinion is the same as concerning sugar. 
It has the advantage that it may be added to food as a laxa- 
tive when one is necessary, but it is inferior to some fruits, 
if they are obtainable. 

POP-CORN 

Will you please say whether pop-corn is good or healthful for 
children between the ages of three and eight? 

There is a long gap in digestive ability between the years 
three and eight. Pop-corn eaten at a meal, and well chewed, 
although not a desirable food, may be borne well by many 
children of eight. "We should not think of giving it to those 
of three. But there remains the objection that children do 
not eat pop-corn at meals, but at other times when they 
should not eat anything. 



OATMEAL GRUEL AS A LAXATIVE 

Please send directions for making oatmeal gruel to use as a 
laxative. 



Oatmeal gruel is made in many ways to suit the taste— t. e., 
with or without milk, with or without sugar, etc. It should 
always be salted. When used as a laxative diluent of milk 
it should be made only of oatmeal, boiling water, and salt. 
Four tablespoonfuls of the meal will be enough for a quart 
of water. Add salt, say half a teaspoonful, to the oatmeal 
in the cooking- vessel ; pour on the quart of water. The pre- 
cise method and time of cooking will depend upon whether 
you use a double "farina" kettle or a simple saucepan. In 
the latter case it must be stirred to prevent burning, and the 
evaporated water made good from time to time. An hour's 
boiling is usually enough. 



428 THE CENTURY BOOK FOR MOTHERS 



IS OATMEAL "HEATING"? 

My little girl of four is very fond of oatmeal, and, in fact, pre- 
fers it to anything else. During last summer some of our 
friends thought we gave her too much oatmeal, considering it 
too heating. Is this the case ? And if so, is not oatmeal, then, 
of corresponding value in winter? 

It is one of the stock phrases which some people are fond of 
repeating, that oatmeal is "too heating." If this phrase has 
any particular meaning, it is this, that some persons, par- 
ticularly in summer, do not easily digest oatmeal, as evi- 
denced by flatulence, by constipation in some cases, or by a 
tendency to skin eruptions. If these or any other symptoms 
which your physician thinks may be fairly attributed to the 
oatmeal occur, it would be proper to stop or diminish the oat- 
meal ration. But you say that it does agree with your child 's 
digestion, and mention no other symptoms. So we are left 
to conclude that your friends have no other ground for their 
suggestion than the desire to appear wise by giving irrespon- 
sible advice. 



INCOMPATIBILITY OF FRUIT AND MILK 

What is there in the popular idea that milk and fruit do not 
go well together? My little ones are inclined to constipation, 
so they need all the fruit they can digest ; but they must either 
go without milk, which is one of their chief articles of diet, 
or eat the fruit at their meals with their milk, or eat the fruit 
between meals, which seems to me a bad habit to establish. 
Which of the three ways is best? 

The incompatibility varies with different fruits and with 
different digestions. So far as a general rule can be given, 
it is this : You know that many fruits— baked apples, peaches, 
berries— are habitually served with cream, said ''cream" 
being as often as not only top-milk. Very acid or unripe 
fruits do seem sometimes to disturb the digestion of milk. 



FEEDING PROBLEMS 429 

Ripe, sweet fruits generally do not have this effect, and may 
be given, if the child is old enough to have fruit, irrespective 
of milk. One reason, it seems to us, that milk and fruit dis- 
agree is this: They are eaten together, and whole berries, 
perhaps, with tough skins, or unchewed pieces of larger fruit, 
are washed down and cannot be readily attacked by the di- 
gestive juices. We have supposed that the indigestion some- 
times following huckleberries and milk, for instance, was 
due to this fact, and would not have occurred if the berries 
had been served dry and the child obliged to chew them 
well, the milk being swallowed later in the meal. In giving 
fruit to children the parent must carefully select for each 
child what it is to eat, and see that it is properly prepared. 
Cooked fruit and milk rarely disagree— the traditional baked 
apple and milk, for instance. 

The habit of giving fruit between meals is not bad if the 
fruit hour is fixed and it is made a meal. This may be on 
rising— which, when constipation exists, is a very good time 
—or it may be between breakfast and the midday meal. To 
young children we prefer not to give any uncooked food ex- 
cept milk after the latter meal. 

STRAWBERRIES AT FOUR YEARS 

I would like to know what you think of strawberries for a child 
of four years? 

There is no fruit about which there is so much uncertainty 
as the strawberry, owing to the quite common idiosyncrasy 
which makes its possessor unable to eat the strawberry (as 
well as some other things) without severe indigestion or an 
attack of hives (urticaria). Nevertheless, if experiment re- 
veals no such peculiarity, we believe strawberries admissible 
at the age you mention, provided they are fully ripe and 
fresh, that they are taken early in the day or at noon, and do 
not form a part of the same meal as milk. Good berries, ripe 
enough to eat, need but little if any sugar (how good the old 



430 THE CENTURY BOOK FOR MOTHERS 

hillside berry was without any!), and taken with a biscuit 
or a slice of bread, the quantity moderate, make a proper 
part of the midday meal, or may form the forenoon luncheon 
usually needed by the four-year-old. 

SMUGGLING MILK INTO THE BILL OF FARE 

What is to be done if a child refuses milk altogether? My little 
girl of a year and a half takes the milk with her cereals nicely, 
but does not like it by itself or in the shape of prepared foods. 

If I cannot teach her to like it, what would you advise? 

There are some children who do not like milk. The only 
way is to coax in all you can. A little later on it can be hid- 
den in various dishes; for instance, celery soup and clam 
broth can be made to introduce a good deal of milk into the 
system. If these do not succeed, the albuminoids can be 
made up by the use of broths, finely chopped meats once a 
day, eggs occasionally. The fats can be made up by butter, 
cream, egg yolk, fat meat, or, in an emergency, cod-liver oil. 

BANANAS, APPLES, AND ORANGES 

Can a healthy boy twenty-two months old eat half a banana at a 
time, or any banana at all? And if not, why not? He has 
been given a quarter of an apple at once and part of an orange, 
and sometimes grapes, with, of course, skins and seeds always 
removed. These three last fruits he has had for a number 
of months past. 

He should have no uncooked banana at all. Only the most 
accomplished masticator can do anything with the tenacious 
pulp. It is palatable, but even for adult use it should be 
either very thinly sliced or scraped up. In our judgment, it 
it a hazardous experiment to give this fruit to any child 
who is not at least five years of age. The apple is not 
advisable, but if you scrape the pulp very fine it may be 
given if constipation demands it; otherwise, wait. The 



FEEDING PEOBLEMS 431 

orange, carefully divested of seeds and of the fibrous part 
(best accomplished by cutting the orange across and feeding 
with a spoon what you wdsh to give the child), w^ll prob- 
ably do no harm; the grapes, perhaps, are also admissible if 
carefully prepared, but in hot w^eather they w'ould better be 
omitted. A child of the age mentioned should not be allowed 
to feed itself wdth fruit. 

THE USES OF SAGE-TEA 
Is sage-tea beneficial to children? 

Sage-tea is sometimes of use medicinally. It was anciently 
held in high esteem, but is now chiefly used in domestic medi- 
cine. It makes a good gargle, especially wdth the addition 
of alum and honey. It is also useful as a tonic to the stomach 
when there is flatulence, and sometimes allays nausea. Made 
w^eak, it is a grateful drink to many persons in fever. 

THE ABUSE OF SUGAR 

Should sugar be a constant ingredient in the simple food (bread 
and milk, rice and milk, etc.) given to a child under two years 
of age? One hears that too much of it causes digestive dis- 
turbances. Is it necessary for the child to have any? 

In our opinion, after a child is old enough to eat rice or 
bread, sugar is not needed at all. If it can properly digest 
these articles of food it can, from their starchy constituents, 
manufacture enough sugar for its needs. We think it far 
better to teach the child to take its bread and milk or rice and 
milk with a proper seasoning of salt, and without any sugar 
at all. To add sugar is only to tickle the palate at the risk 
of the digestion and general health. 

BREAKING THE "BOTTLE HABIT" 

Can you tell me how to cure a child of the "bottle habit"? Al- 
though nearly four years of age, she still clings to her bottle, 



432 THE CENTURY BOOK FOR MOTHERS 

and if we wish to spend the day or evening out, that bottle 
has to go along. Is it good for a child of that age to stick to 
the habit so? We have tried all manner of expedients without 
avail. 

We have seen such eases of late use of the bottle. The habit 
is of no use to the child, perhaps not a positive detriment 
to her digestion, but it is a harm to her morale to be allowed 
to dictate to her parents at her age. W^e have known in- 
stances of the parents waiting until the child w^as old enough 
to be shamed out of the habit. But there is one simple w^ay, 
and only one, of breaking the habit— that is to take aw^ay the 
bottle. It will make a trouble for tw^elve or twenty-four 
hours, but if the parents do not yield— simply preparing the 
food and offering it in a glass— at the end of that time it wdll 
be taken, sparingly, perhaps, at first, but presently in full 
quantities. This assumes, of course, that there is no de- 
formity of the mouth, and that the child can drink w^ater. 
It strengthens the resolve of yielding parents to break every 
bottle in the house before beginning the experiment. It is 
better not to begin than to yield. 

TEACHING BABY TO EAT; THE NEED OF WATER 
TO QUENCH THIRST 

My six-months-old baby is a large twenty-four-pound boy who 
has never been sick and is just as healthy and happy as a baby 
can be. Two teeth are now through without any trouble, and 
this leads me to suppose the time has arrived for feeding him, 
as up to the present he has never tasted anything but milk of 
nature's own providing. There seems as yet to be no lack of 
this natural supply, but is not the presence of the teeth an 
indication that he ought now to be taught to eat? If so, what 
food ought first to be given him, how often, and in what 
quantities ? 

Ought little babies to drink cold water? 

The presence of teeth is not an indication that he ought now 
to be taught to eat. Inferences from "indications" have 




FEEDING PROBLEMS 433 

to be drawn very carefully, or else Ave shall overlook very 
evident counter-indications. If the child Avere taught to 
take artificial food his two teeth (incisors) would be of little 
help to him; he cannot bite liquid food with them, and he 
cannot chew solid food until he gets his molars. This child's 
weight and prompt dentition are evidence, so far as they go, 
of his health and proper nutrition. The question for you to 
decide is how much longer you can properly nourish him 
alone. This question you may have to refer to your family 
physician. When you have decided this you can begin to 
teach the child to take artificial food as a preparation for 
complete weaning. 

Cool water may be given to babies, but not iced water, 
as a rule. They often are thirsty and nurse only to quench 
thirst and not hunger. The quantity of water given at one 
time should be small. 



PURE VERSUS DILUTED MILK AT TWO 
AND A HALF YEARS 

Is it advisable to dilute the milk for a child of two and a half 
years? It is claimed by my wife that the milk is too rich, and 
that with a slight admixture of water it agrees better with 
our boy. I think that since milk is his principal nourishment 
he ought to have it pure, and that if rich it is all the better on 
that account. 

The child enjoys his meals and seems to be in good health, as 
far as we can tell. 

The answer depends upon the quality of the milk and the 
digestive powers of the child. A child of two and a half 
years, of ordinary digestive power, can take the milk— espe- 
cially if warmed slightly— of an ordinary cow undiluted. 
Jersey milk, with an unusual amount of cream, may be too 
heavy if pure. But it is always safe to err on the side of 
over-dilution, and to make up the nourishment, if necessary, 
by increased quantity. 

28 



434 



THE CENTURY BOOK FOE MOTHERS 



BUTTERMILK AS FOOD FOR CHILDREN 

Do you consider buttermilk a suitable drink for a child of four? 
My daughter is exceedingly fond of it and generally prefers 
it to sweet milk. It agrees with her perfectly. If given at 
all, is it just as good in the morning as at any other time ? 

There is, in our experience, buttermilk and buttermilk. One, 
the buttermilk which has stood a good while before skimming, 
and which is bitter and sometimes sour; this we recom- 
mend to no one. The other is sweet and innocuous. We 
know of no good reason why a child should not drink it. 
It is no more difficult of digestion than ordinary milk, and 
to some, perhaps, less so. Of course, the absence of fat re- 
moves from it the laxative element, and it would probably be 
less laxative than ordinary whole milk. We think it would be 
just as good in the morning as at any time. 



ICE-CREAM 

Do you consider vanilla ice-cream injurious to children above 
three years of age, if given in small quantities and eaten 

slowly ? 



To this question an explicit answer cannot be given. In the 
first place, simple ice-cream (not the remarkable concoctions 
of the confectioner, but a simple mixture of cream and sugar, 
with flavor, frozen), in moderate quantity, would seem to 
be as inoffensive as any sweet that could be devised. But 
whether or not it is so depends upon several things. First 
of all, the same cream which, eaten slowly (small pieces being 
allowed to melt in the mouth), would be harmless, would 
help to set up an indigestion if large pieces were allowed to 
go to the stomach while very cold. 

But in our judgment a great distinction is to be made 
between those who can and those who cannot eat sweets. 
We know that there is a very large class of people who can- 



FEEDING PROBLEMS 435 

not safely eat much of certain things (sweets, starchy food, 
including bread, potatoes, and many others seemingly harm- 
less), without sooner or later suffering for it in some way. 
This group of persons are called the gouty. They are rela- 
tively more abundant among the head-workers than the hand- 
workers. The offspring of such persons early show this in- 
ability to properly dispose of sweets, and to such children 
even ice-cream is not harmless. 



INORDINATE FONDNESS FOR SALT 

My little girl, three years old, apparently healthy, is very fond of 
common table salt. I am sometimes obliged to punish her to 
keep her from eating it in great quantities. Is it injurious? 

A good deal of salt may be eaten without harm except the 
exciting of thirst. Just what quantity is harmful in any 
given case cannot be definitely stated. The best way is to 
give the child a liberal allowance and not allow her to take it 
hepself . Keep account of the amount and watch results, and 
if you find any disagreeable ones that you think probably due 
to the use of the salt diminish the quantity. The exact 
amount meant by ''great quantities," of course, we do not 
know, but the taste and the desires of different adults vary 
greatly, and there is no reason why those of children should 
not. 

WHY FROZEN CREAM IS UNSUITABLE FOOD 

Will you state whether milk and cream undergo any chemical 
change by being frozen? I have noticed so often that cream 
after being frozen does not mix when put into coffee ; the fatty 
part seems to separate and float on top. Does the cream de- 
teriorate in any way for children's use by having been frozen? 

Cream, when first raised, consists of particles of fat held in 
suspension in the watery part of the milk. When this condi- 
tion of emulsion is disturbed the fat separates in the form of 






436 THE CENTURY BOOK FOR MOTHERS 

butter. The object of churning is to mechanically cause this 
change. Much shaking has a similar effect, and we have often 
noticed it after freezing, and suppose that the change is due 
to the freezing. Cream which has become buttery is unde- 
sirable for making infant food ; in fact, the fattest kinds of 
cream, even if fresh, are not so good as lighter sorts. The 
fat cream, if used, should be used in place of butter on bread 
and other things for children old enough to eat them. 



USES OF FAT IN FOODS 

Would any serious difficulty arise from a lack of fat in the food, 

and what would be its first indication ? 
Would not a lack of fat be favorable to the good health of a 

baby who evidently has a strong tendency to an excess of flesh ? 
My youngest has been using artificial food over two months, and 

has been growing large and fat. Is not that an evidence that 

it is agreeing with her? 

Lack of fat would be a disadvantage just as deficiency of 
any of the principal elements of food would be. There has 
been some doubt raised as to whether deficiency of fat is as 
serious a drawback as other deficiencies, and, perhaps, with 
the great safeguards we have against loss of heat in warm 
houses and clothing, the doubt may be well founded. But 
it is better usually to keep the food as near the theoretical 
standard as is practicable. There are other uses of fat, 
as a laxative, for instance, which should not be over- 
looked. Besides, in the first year lack of fat seems to induce 
rickets. 

Fatty food does not much tend to the production of fat in 
the consumer. The sugars and starches are much more fat- 
tening. 

So far as it goes, increase in size is evidence of food 
agreeing. Growth in stature is a better evidence than simple 
increase of fat, which last is consistent with poor nutrition 
in other ways. 



FEEDING PROBLEMS 437 



VARIETY IN FOOD 

When you speak of a simple diet for children, do you mean that 

there should be little variety? 
Do you think it best that a boy of two and a half should have 

oatmeal gruel every morning if it agrees with him, or would 

you vary his diet? 

Simple diet generally means simple in character. Thus, a 
piece of beef roasted or steak broiled would be "simple," 
while the same beef as part of a beef stew would not be. 
We do think, however, that young children should not have 
much variety in kinds of food, while they may have a variety 
in the kind. For instance, take the cereal preparations: 
they are used monotonously as to course, but one may vary 
the course with oatmeal, hominy, or a wheat preparation. 

Unless you see some sign of disagreement with his digestion, 
or he tires of it, we know of no reason why he may not have 
the gruel regularly. 



THE EFFECT OF TEA ON CHILDREN 

I want to ask whether you think that a teaspoonful or two tea- 
spoonfuls of tea, as it would appear in an ordinary grown-up 
person's cup, put into the hot water and milk of children of 
four and six would interfere at all with their health? The 
children do not care to take this drink of hot water and milk 
alone, and if they get the slightest coloring of tea or coffee 
they seem to relish it — more, I think, from the idea that they 
are getting something that others are having than from any- 
thing else. 

It is not probable that the amount of tea would have much 
effect. We cannot definitely say, as the tea, "as it appears in 
an ordinary grown-up person's cup," is a mixture of most 
variable strength. One person may take it five or six times 
as strong as his neighbor. Further, the effects of different 
kinds of tea vary very much, and, moreover, the suscepti- 



438 THE CENTURY BOOK FOR MOTHERS 

bility of different persons is very different, and to some the 
injurious effects seem to be cumulative. Let us assume, for 
the sake of argument, that the tea as mixed is, as such, harm- 
less. What is accomplished? You have made the children 
acquainted with a stimulant which they would better not 
know before adult life, and you have let them understand 
that by persistence they may have at table something which 
one parent at least thinks is not good for them. 



COCOA 

Is cocoa a good breakfast drink for young children? 

By cocoa we understand an unadulterated preparation of 
the roasted nut of good quality. There are all sorts of prep- 
arations on the market, varying from the costly chocolate 
down to the husks or shells, not to mention adulterated or 
spurious articles. For a young child the addition to milk of 
a substance rich in fat and nitrogenous ingredients— as is 
really good cocoa— makes a mixture, in our judgment, usually 
too rich, unless it be understood to be a food and not a drink. 
Chocolate and bread would make a meal, if the power of 
digesting fat is good. The multitude of preparations of 
cocoa from which the fat has been more or less removed we 
do not discuss, as it would require a minute knowledge of 
each preparation. 

FEEDING A PREMATURE CHILD 

My child was a little seven-months baby, weighing only four 
pounds at birth, and now at five months he weighs ten pounds. 
Has he gained as much as he ought to have done under the 
circumstances ? 

Since the third month he has been artificially fed, taking ten 
tablespoonfuls or more at a time of his food every two hours 
in the daytime and two or three times at night. Is he fed too 
much and too often? 



FEEDING PROBLEMS 439 

Should he be considered and treated, as regards his food, as a 
five-months or a three-months-old baby? 

The gain seems very satisfactory, his weight being two and 
a half times what it was at birth. 

Probably you could begin to widen the intervals of feeding 
with advantage. 

It is not easy to say for how long and how much allow- 
ance should be made for premature birth. We think it safe 
to make an allowance, gradually diminishing, until the end 
of a year, and longer if the child is feeble. Your baby at five 
months, for instance, could be considered a four-months baby ; 
at ten months, as nine and a half. This, of course, is only 
approximate, and the real guide is the condition as to 
strength, etc., of the particular baby. 



BUTTER AND EGGS FOR A CHILD OF 
DELICATE DIGESTION 

I have a little girl of two and a half years, and should very 
much like to have your views regarding butter and eggs as a 
regular diet for her. She has had added to her hominy and 
milk a little cream, also a little cream to her milk for break- 
fast. After the hominy she has had a soft-boiled egg, topping 
off with bread and butter. She has just had a bilious attack, 
vomiting at intervals for some hours. She threw off consid- 
erable bile. Finally, after a sufficient lapse of time, a mix- 
ture of bismuth was given to her, when she went to bed and 
slept soundly throughout the night, and was "as bright as a 
button" in the morning, and is all right now. What I wish 
to avoid is a repetition of the attack. What, then, is your 
opinion of butter, in the first place, if given liberally to chil- 
dren, and what do you think of a soft-boiled egg every morn- 
ing as part of baby's breakfast? My little one has a delicate 
frame and digestion, but is perfectly well and healthy. 

Butter in moderation is usually advantageous as being an 
easily assimilated animal fat. But it would seem that you 



440 THE CENTURY BOOK FOR MOTHERS 

have given it to your little girl without moderation. Thus, 
she had it in the milk on her hominy; she had more in the 
added cream, again in the milk she drank and in the second 
added cream, and then she "topped off" with more on her 
bread. Probably, altogether, she got at least as much as a 
man of strong digestion would take for his breakfast. It 
does not seem necessary to add cream to good undiluted milk 
—indeed, usually it is injudicious, and a child who uses much 
good milk does not need additional butter. 

The fresh egg also is usually well borne, and probably will 
be again if you moderate the amount of fat you give with 
it. Try hominy, milk, and the egg, giving the egg on alter- 
nate days, limiting the amount of milk at that meal and 
watching the effect. 

The fact that your little one has a delicate digestion should 
render you careful, and she may be one of those persons (who 
are not so common as is supposed) with whom eggs do not 
agree ; but before believing this, try the above suggestions. 



PROPER DILUTION OF CONDENSED MILK 

Nature has deprived me of nourishment for my little one, who 
is five months old. I have given her condensed milk, properly- 
diluted with water that has been boiled, with a tiny pinch of 
salt and a little lime-water added to it. These are the pro- 
portions: six ounces boiled water, two teaspoonfuls of con- 
densed milk, a pinch of salt, two teaspoonfuls of lime-water. 
She takes about this amount every three hours during the day 
and about half the amount once during the night. She 
weighed seven pounds at birth, and now, at five months, weighs 
seventeen pounds, and seems very strong. Her only difficulty 
is constipation, which I have heard is a usual occurrence with 
bottle-fed babies. 

Would you continue with the condensed milk, when she has 
gained so much, and seems so well, and I have used nothing 
else? If not, what do you recommend that is better? 

Am I using the right proportions for her age, and are forty-two 
ounces too much in quantity for twenty -four hours? 



FEEDING PROBLEMS 441 

When a child is really doing well we do not advise change 
even if the food is not what it ought to be. Many children, 
like many adults, have sufficient digestive power to be nour- 
ished by imperfect food. In practice— especially in dispen- 
sary practice— condensed milk is often the best food that can 
be obtained, and its deficiency in fat can be made up by 
using cod-liver oil, and the sugar deficiency, which exists if 
it is properly diluted, made up by adding sugar. 

This being the case, it is not easy to say what are correct 
proportions as regards a food which is admittedly imperfect. 
Condensed milk which is preserved and canned is inferior 
to that made by the same makers and sold in many cities 
from delivery wagons. This last is only a substitute for 
good, ordinary milk whenever the latter is not to be easily 
had. We think that you dilute the condensed milk too much 
for an adequate food; its high dilution makes it easily di- 
gested but not very nutritious. By increasing the strength 
of the mixture somewhat, from time to time, you can increase 
its nutritive power while you watch the digestion. If you 
wish to try another kind of food altogether, we would sug- 
gest that it be done under the advice of a good physician 
who has looked the baby over carefully to see what is lacking 
in her nutrition. 



A "HARD-REARED" BABY 

My baby has attained the age of sixteen months. He has been 
unavoidably bottle-fed, and has been what many would call a 
"hard-reared baby," but now seems perfectly healthy and 
fairly developed, walking, but not talking, and boasting the 
possession of ten teeth. His diet is still confined, of course, 
to milk, cream, oatmeal, an occasional fresh egg, roast potato, 
and bread and butter, of which last he is inordinately fond. 

So far so good. But baby has one or two bad habits that seem 
to grow with his growth — first, exceeding restlessness at night ; 
second, there seems to be an impossibility of weaning him of 
night feeding, or drinking rather. 

lie has never, I believe, slept a night continuously, whatever his 



442 THE CENTURY BOOK FOR MOTHERS 

state of health. Just now his program is to wake once, say- 
about 2 A.M., scream violently for a few minutes, and insist 
on having some one take him from his crib to amuse and 
pacify him, and finally, after about half an hour's recreation, 
he condescends to accept a full bottle and retires with his 
treasure. Frequently he drinks two or three bottles of milk 
through the night, although in the day he never looks for one, 
drinking from a glass or cup at meal-times. 
I am quite at my wits' end. What am I to do? If I let him 
cry on without heed or help, it seems to me he will certainly 
cry himself to sickness, so violently does he set about it; and 
how can I wean him from drinking? 

We will give what help we can on the facts stated. The 
phrase "hard-reared" we interpret to mean that his rearing 
was difficult, either from distinct sicknesses or from some 
delicacy or feebleness; if the latter, most probably digestive 
derangements. He now, at sixteen months, has ten teeth, 
probably the eight incisors and two of the first molars. 

His "two bad habits" may be considered as manifesta- 
tions of one. To give the cause of them, of course one should 
know a great many things not stated in the query. But one 
cause is suggested by the facts given. A child with prob- 
ably only two molars has among its articles of diet two things 
notably hard of digestion at his age, and digestible only 
after prolonged chewing— namely, potato and bread. Both 
of them contain starch in a very large proportion. Fine 
wheat flour contains, according to some analyses, upward of 
seventy per cent, of starch, and bread made from it nearly 
fifty per cent., some of the starch having been changed by the 
raising and cooking of the bread. Eaw potato has, say, nine- 
ty-two per cent, of starch. Now, without claiming, as some 
seem inclined to do, that starch is the great poison of infancy, 
it cannot be denied that it is very indigestible to children. 
Only prolonged chewing makes its digestion probable in 
adult life, and to many people it is always indigestible. To 
an infant as yet unsupplied with chewing-teeth (molars) it 
must be very difficult of digestion. The form of indigestion 



FEEDING PROBLEMS 443 

need not be one that must cause immediate pain, or perhaps 
any great pain at all, but it may lead to derangements of a 
remoter kind. This may not be the case with your child, but 
we cannot help associating the starch and the restlessness. 

The demand for the ''full bottle" is probably a natural 
sequence of the other troubles, or it may be partly habit— 
we cannot speak with precision for want of information. AYe 
presume you have tried water to make sure it is not thirst 
that troubles the child. If you have not, try if a bottle of 
water, not too cold, will not content him. Many children, 
however, demand the bottle because they have been taught 
all their short lives to expect something to be put into their 
mouths as the preliminary to sleep. They do not need food 
any more than many men need spirits, but they have gained 
a habit. If we had to deal with a wakeful or restless child, 
and could find out only the things you have stated, we should 
first get rid of the starch, giving in place of the milk diet for 
one meal some beef-juice or good plain broth (bouillon) of 
beef or mutton. If he craved bread he should have only the 
hard crust, which is more digestible than the soft crumb and 
portions of which cannot be swallowed until they have been 
diligently chewed off from the piece. The details of the re- 
maining management would depend upon the success attend- 
ing the change of diet. It is well, however, in the case of any 
''hard-reared" child, to have occasional advice from the 
physician, who can work out all the real facts. What has 
been said above is based on the few placed before us. 

PROBABLE OVERFEEDING; FREQUENT CHANGES OF 
FOOD; EXCESSIVE VOMITING 

Ever since my baby was born he has vomited a great deal. I 
gave up nursing him when he was three months old and have 
tried everything for him, but the vomiting still continues, to 
an almost unlimited extent. The child grows steadily, never- 
theless. Would you advise me to keep on trying the different 
foods until I get something which seems to agree with him, 
or go back to the sterilized milk with water and a little sugar 



444 THE CENTURY BOOK FOR MOTHERS 

and lime-water, and just endure the vomiting ? It occurs from 
the time he has taken his bottle possibly until three hours 
after. Is it healthful or not? 

Vomiting is not healthful. Regurgitation of food, if the 
amount has been excessive, is not a- sign of disease but of a 
physiological protest on the part of the stomach against such 
treatment. Just how long you have been trying to get a 
food to suit does not appear, as the age of the child at the 
time of w^riting is not given, and it may be that the child's 
digestion could be put right promptly by a little medical 
advice. But on general principles v^^e may say that we do 
not approve of changing from food to food. The changes are 
not usually made for any reason except that the present one 
is not satisfactory. No attempt is made to ascertain why 
it disagrees, nor if the next would probably be better. If we 
had to try we should expect better success from a good milk 
mixture, varying the dilutions as indications arose, than 
from any series of artificial foods. 

SUGGESTIONS FOR IMPROVING THE DIETARY 
IN A CASE OF SLOW TEETHING 

My baby is fifteen months old, has only seven teeth, and weighs 
twenty-seven pounds. I feed her on broth and milk only, 
diluted with oatmeal gruel. The doctor says her slow teething 
is due to insufficient nourishment, and advises me to put soda 
crackers in her milk, and give her grits, biscuits, and meat to 
eat. Do you think she should have them ? Are crackers better 
than light bread? 

You put us in the dilemma of choosing between our own 
opinion, formed on general principles, about a case which 
we have not seen, and the opinion of a physician on the spot 
who has seen the case. It is usually safer to take the opin- 
ion of the man near by. Nevertheless, there is no harm in 
telling you the general principles which would guide us. 
First of all, the weight, twenty-seven pounds, is good enough 
for a child of fifteen months. The teething is slow. One 



FEEDING PROBLEMS 445 

would expect all the incisors and the first molars in a breast- 
fed child of fifteen months; a bottle-fed child might be less 
forward. The weight and the state of teething are all the 
facts concerning the child you give us. Perhaps the physi- 
cian based his judgment on many other things which you 
have not told us or have not noticed. However, proceeding 
on these two facts as a basis, we should say that backward 
teething alone is not sufficient ground for us to make a diag- 
nosis of rickets, that form of malnutrition which particu- 
larly retards the development of the teeth. But assuming 
that we did consider that such a child, whose weight was be- 
yond the average, was really insufficiently nourished, what 
would be the food we should add ? Would it be starchy food, 
like bread or crackers, cereals, or potatoes? Now, for the 
proper digestion of starchy articles, they must be well chewed 
and mixed with saliva. A child without chewing-teeth can- 
not chew well, but if he had abundant saliva we might let 
him try some of the starchy articles. But they must be given 
in such a way that the saliva shall be mixed with them. This 
is not accomplished by mixing them with milk to be quickly 
swallowed, but by giving them as dry as possible, so that they 
must be sucked and chewed a great deal before swallowing. 
For instance, giving a crust of bread from which the soft 
part has been scraped away, or a slice of stale bread browned 
slowly in the oven, buttered when cold if butter be desired, is 
a favorite method with us for accomplishing this purpose. 
The kinds of soda crackers with which we are familiar are 
generally crumbly and not very well adapted to the purpose. 
If browned, as before described, slowly in the oven to a 
golden-brown tint, they will do better. There are many 
things that may be given, but we have confined ourselves to 
the questions propounded. 



LOSS OF APPETITE; IMPERFECT NUTRITION 

My baby girl is nearly eleven months old; she weighs twenty- 
two pounds and was doing nicely until lately, when she seems 
to have lost all her appetite, taking hardly a bottlcful throufch 



446 THE CENTURY BOOK FOR MOTHERS 

the day. I feed her on milk and some artificial food. What 
had I best do? She has but two teeth, yet she is said by all 
to be a healthy-looking child. Her hands, however, have been 
often cold and clammy. 

The little girl has one evidence of good health— namely, fair 
weight. On the other hand, if a child of eleven months has 
but two teeth there is reason to think that in some way its 
nutrition is defective. In this case, moreover, the hands 
have been cold and clammy, which may be taken as an evi- 
dence of an imperfect circulation. At the moment of our 
correspondent's writing the appetite had failed. There are 
many points which are not stated, but we may give her a 
few hints regarding things to be looked after in her baby's 
case. The slow coming of teeth— in this instance not so very 
slow— is usually suggestive of that form of malnutrition 
called rickets. 

The loss of appetite in a small child will ordinarily be 
better overcome by the removal of the cause than by the ad- 
ministration of tonics. The mother should, therefore, look 
to the condition of the digestive apparatus as well as she is 
able. She should notice if baby 's tongue is clean or furred ; 
whether the movements are natural as to color, consistency, 
and smell, or whether they are too dark or too light colored 
and chalky, constipated, or too liquid, offensive in smell, or 
too sour. Even if she is unable to correct the abnormal con- 
dition, it will enable her to give to the physician, when called, 
so clear an account of the state of affairs that he can pre- 
scribe with much greater certainty and effect. The mother 
may, however, do something by herself. If there be con- 
stipation with the furred tongue, the familiar remedy of the 
spiced syrup of rhubarb with the bicarbonate of soda in 
proper dose will be pretty certain to afford relief, at least for 
the time. If the movements are white and chalky, no rem- 
edy that can be prudently used without medical advice will 
be found more beneficial than the phosphate of soda ; a small 
pinch of the powdered phosphate may be dissolved in a bottle 



FEEDING PROBLEMS 447 

of milk, once, tAvice, or thrice a day; it is not objected to, 
as it resembles common salt in taste. If the stools are sour, 
the use of an alkali— lime-water if they are loose, bicarbon- 
ate of soda if they are constipated— may be of assistance. 
Better than all dosing, however, for correcting a disordered 
digestion usually is the change of food— bottle-fed children 
are here alone considered — and our preference is to give good 
sweet milk, diluted with water or barley-water, in place of 
any prepared or starchy food. By means of this change and 
the use of the simple remedies mentioned, much can be done 
to improve the condition of a baby's digestion; still, it seems 
to us the part of wisdom not to carry domestic practice very 
far if good medical advice can be obtained, but rather to 
procure explicit directions suited to the particular case, and 
exactly to follow them. 

DISTASTE FOR MEAT 

My little girl of five has from the time she first began to eat 
solid food had a dislike for meat in any shape. Neither steak, 
nor chops, nor fowl will tempt her. She is correspondingly 
fond of cereals, vegetables, and fruit, and eats a fair amount 
of bread and butter, eggs, etc. She has always liked milk. 
She is what is generally called a nervous child and not par- 
ticularly robust, although in fair health most of the time. 
Do you think that she ought to be forced to eat meat? I 
don't like to make her uncomfortable at meal-times, and there- 
fore have not tried to persuade her to eat it; but if it is best 
for her health to do so, I shall, of course, do everything to 
overcome her dislike. 

There are few more disagreeable minor nuisances in society 
than people who are over-fastidious in the matter of diet, 
and education ought from the start tend to make children 
eat all wholesome food. Still, it is not advisable to force a 
child to eat what it honestly loathes. The opposite mistake 
is to humor its whims until one can hardly find enough to 
keep it from starvation at a table bountifully supplied with 



448 



THE CENTURY BOOK FOR MOTHERS 



proper dishes. As a nation we depend too mucli upon flesh- 
pots ; yet a single meal daily at which meat is served is almost 
a necessity if one would have sturdy growth of health and 
strength, unless, indeed, a liberal supply of milk and eggs 
be deemed a sufficient substitute for meat. Coax and tempt 
your little girl to overcome her idiosyncrasy. Distaste for 
meat is not uncommon, although hardly so frequent as is the 
disposition to eat meat heartily to the exclusion of vegetables 
and cereals. Begin with insisting that a small piece of juicy 
meat shall be slowly masticated and swallowed before a cov- 
eted dainty is given. 



INDEX 



INDEX 



Abdomen, appearance of, in illness, 

142 
Abdominal fat, excess of, 392 
Absorbent cotton, for sterilized bottles, 

98 ; for surgical needs, 184, 301 
Accidents, what to do in case of, 169- 

181 
Acetic acid for removal of warts, 222 
Aconite, tincture of, 164 ; poisoning, 181 
Adenoid growths, 138 ; meaning of, 198*; 

cause of catarrhs, 238 
Adhesive plaster, use of, 173 
Ailments and troubles, minor, 193-218 ; 
bed-wetting, 206; bed-wetting in a 
nervous child, 207; cause and cure of 
hiccough, 208- cause of pin-worms, 
213; causes .^ treatment of colic, 
193 ; causes of sor?* mouth, 203 ; coated 
tongue, 201- coM feet as a conse- 
quence o^ ^'i.-* clothes, 197; colic 
accomp .rsing, 195; colic and 

teething, x^ ^ , <^i'acked lips and chafed 
skin, 218; c .e for cold hands, 196; 
drowsiness following a bump on the 
head, 217; excessive hosebleeding, 
210; enlarged uvtda, 199; enlarge- 
ment of glands, 198; fainting, 218; 
gritting the teeth as a symptom of 
worms, 211 ; patches on the tongue, 
199; persistent itching of the nose, 
214; perspiring feet, 197; prevalence 
of "sore mouth, "202; probable cause 
of mouth-breathing, 198; roughness 
of the voice, 206; signs of worms, 
212; swollen tonsils, 203; treatment 
of iDumps, 216; treatment of pin- 
worms, 213; three-months' colic, 196; 
what to do for an attack of false 
croup, 215 
Air, fresh, in relation to colds, 233 
Albuminoids, of breast-milk, 78 
Alcohol, uses of, 171, 172, 185 
Alcoholic beverages, cautions concern- 
ing, 391 ; in fever, 294 ; supposed ad- 
vantages of, for the nursing mother, 
37 
Alkaline washes, uses of, 270, 271 
Alkalis, as emetics, 180; for indiges- 
tion, 261 
Aloes tincture, for nail-biting, 305 
Alum, powdered, as an emetic, 187; for 
nosebleed, 210 



Ammonia, antidote for, 180 ; for the 

nursery pharmacy, 186; various uses 

of, 171, 172, 178 
Anal obstruction in the new-born, 25 
Animal foods, 111-115 
Anise, spirit of, 187, 194 
Ankle, sprain of, 173 ; weakness of, 

247, 252 
Anodynes, experimenting with, 317; 

warning against, 395 
Antidotes, various, in accidental poi- 
soning, 179, 189 
Antimony, antidote for, ISO 
Antipyrine poisoning, 181 
Antiseptics, for internal use, 275 ; in 

colds, 236 ; in domestic surgery, 188 
Antitoxin, experiences with, 279, 280 
Appetite, loss of, 445 
Apples, baked, 120; as laxative, 254; 

when permissible, 107, 430 
Aromatic spirits of ammonia, for the 

heartburn of pregnancy, 7 
Arrowroot gruel, 99 
Arsenic, antidote for, 180 
Artificial feeding, expediency of, 35 ; in 

its effect on weight, 00 ; proprietary 

foods, 80 
Asafetida, tincture of, for colic, 194; 

for nervousness, 386 
Asparagus, 116, 254 
Ass's milk, 412 
Astigmatism, 345 
Atomizer, use of, in colds, 241 

Baby, care of new, 25-29 ; deformities 
to be inquired into, 25 ; exercise, 40- 
43; first bath, 13, 26; special pre- 
cautions. 27 ; the navel-string, 28 

Baby-basket, 13; — carriage. 40, 57; — 
jumper, 398 ; — powder, 368 

Backwardness, in school children, 76 

Bacteria, in milk, 85 

Banana, value of, 121, 430 

Band, danger from tight, 396 ; knitted, 
376 

Bandages, how to make, 184 

Barefoot, advisability of going, 383 

Barley-water, as a diluent, 97 ; prepa- 
ration of, 100, 423; to prevent curd- 
ling of milk, 201 

Bath, as a remedial agency, 151-155; 
cold, for nervousness, 370; during 



451 



452 



INDEX 



pregnancy, 5; effects of cold and 
warm, 324; how to give, in illness, 
153; medicated, 152; outing after, 
326 ; preparation for baby's, 15 ; 
sponges. 15 ; temperature of, 38 

Bathing, at night, 324 ; baby's bath- 
tub, 13; in the surf, 39; routine of, 
38 ; soap, 325 

Bed-wetting, causes of, 206; in a ner- 
vous child, 207 

Beef, in the child's diet, 112 

Beef-juice, 100 

Beef -tea, 100 

Beet, 118 

Belladonna, for bed-wetting, 207; oint- 
ment for drying up the mother's 
milk, 391 

Berries, value of, 121 

Bicarbonate of soda, as a laxative, 255 ; 
as disinfectant, 185; for burns, 173, 
186 ; for colic, 187 ; for weak diges- 
tion, 261 

Bichlorid of mercury, 12 

Bicuspids, appearance of, 69 

"Biliousness," 262, 297 

Binder or band, cautions as to, 300 ; 
use of, 46 

Biscuit, 105 

Bismuth, as affecting the stools, 142 

Bites, of dogs, etc., 171 ; of insects, 171 

Biting of the nails, 304 

''Black-heads," 272 

Bladder, irritation of, as cause of bed- 
wetting, 207 

Blemishes, various, 219-232 

Blood, in the bowel discharges, 132, 142 

Bones, as affected by infantile scurvy, 
127 ; changes in, due to rickets, 125 

Borax, for sprue, 200 ; uses of, 171 

Boric acid, as disinfectant, 12 ; as nip- 
ple-wash, 36 ; in cleansing eyes, 28 ; 
in domestic surgery, 185 

Bottle-feeding, constipation in, 255 ; 
general rules, 80-99 

" Bottle habit," 431 

Bottles, cleansing of, 94 ; graduated, 94 

Bowel, falling of the, 301 

Bowels, disturbances of the, 124, 132; 
movement of, during nursing, 195 

Bow-legs, 227, 228, 247 

Braces, for bow-legs, 228 

Brain, concussion of, 142; water on, 
298 

Brandy, for diarrhoea, 134 

Bread, composition of, 104; Graham, 
254, 424; harmfulness of new, 424; 
value of, in the nursery, 118 

Bread-crumb, with meat or eggs, 105; 
puddings, 120 

Breakfast -meal, 108 

Breast milk, amount at a nursing, 314 ; 
as affected by nervousness, 386 ; can 
the nurse's or mother's milk be poi- 
sonous? 411; constituents of, 77; evi- 
dences of sufficient supply, 34; flow 



after delivery, 411; method of dry- 
ing up the mother's milk, 391; objec- 
tions to giving mother's milk with 
spoon, 413 ; signs of insufficient, 415 ; 
supply, as compared with allowance 
of bottle-fed babies, 416 ; testing the 
quality, 412 

Breasts, care of, during pregnancy, 7 ; 
sensitiveness of, 387, 388 

Breath, holding of, 303 

Breathing, as altered by illness, 140 

Bromides, uses of, 188 

Bronchitis, beginning of, 235; cough 
of, 141; mistaken for pneumonia or 
pleurisy, 236 

Broths, 100 

Bruises, treatment of, 172 

Bumps, drowsiness following, 217; 
treatment of, 172, 216 

Burns, treatment of, 173 

Butter, for a child of delicate diges- 
tion, 439; of breast milk, 78, 79 

Buttermilk, 434 

Cake, admissibility of, 120 

Calomel, 159 

Camphor, ice, 218; tincture of, in hot 
applications, 156; to allay irritation, 
171 

Candy, objections to, 123; supposi- 
tories, 256 

Cane-sugar, as substitute for milk- 
sugar, 79 

Canine teeth, 67 

Canned vegetables, value of, 118 

Canton flannel, for garments, 51 

Capsicum, for colic, 194 

Carbohydrates, in breast milk, 79 

Carbolic acid, antidote for, 180 ; as an- 
tiseptic, 12 ; for burns, 173 

Carminatives, for colic, 135, 187, 194 

Carriage for baby, outfit of, 40, 57 

Carron oil, 173 

Carrot, as an anti-scorbutic, 127 ; value 
of, 118 

Casein, of breast milk, 78; of cow's 
milk, 87 

Castor-oil, how to give, 165; uses of, 
133, 159 

Catarrh, causes and treatment of, 238 ; 
communicability of, 239; meaning 
of, 235; of the intestines, 212; of the 
stomach, 259; of throat or vnnd- 
pipe, 242; preceding whooping-cougb, 
243 

Catechu, tincture of, 263 

Cathartics, for household use, 186; in 
bowel disorders, 159; uses of, 133 

Catheter, for enemas, 183 ; in colic, 194 

Catnip tea, for colic, 135, 196 

Cauliflower, 117 

Cautery, for removal of growth at the 
navel, 226 

Celery, 117, 254 

Cement or bony layer of the teeth, 66 



INDEX 



453 



Cereals, admissibility of, in the child's 
diet, 99; merits of various, 425 

Chafing, due to napkins, 48 

Chalk, as an emetic, 180; mixture, 263 

Chapped skin, 218 

Chest, changes in, due to rickets, 125 

Chewing-gum habit, 305 

Chewing-teeth, 104 

Chicken-broth, value of, 101 

Chicken-pox, eruption of, 147; incuba- 
tion period of, 145; period of inva- 
sion, 146 

Chilblains, 174 

Chloral, in convulsions, 178; poison- 
ing, 181 

Chloroform, in convulsions, 178 

Cholera infantum, 133 

Chop, when admissible, 105 

Chorea, 293, 374 

Circumcision, need of, 74 

Cleft palate, 230 

Clothing, 44-58, 244 

Club-foot, 73 

Cocoa as beverage, 122, 438 

Cod-liver oil, against worms, 213 ; how 
to give, 165 : in scrofula, 294 

Cold-cream, use of, 218 

Colds, 233-242 ; causes and cure of ca- 
tarrh, 238; comprehensive questions 
regarding, 235; fresh air in relation 
to, 233; head-cold, 241; starving a 
cold, 241; taking cold easily, 240; 
treatment of, 237; various kinds of, 
233 

Colic, accompanying nursing, 195; 
causes and treatment, 193; cry in, 
35; intestinal, 135; relation to teeth- 
ing, 194; supposed to be due to 
nervousness in the mother, 385; 
" three-months', '196 

Collodion, in domestic surgery, 184 

Color-blindness, 73 

Comedo, or "black-heads," 273 

"Comforter," objections to, 302 

Compresses, cold, 155 

Concussion of the brain, vomiting in, 
142 

Condensed milk, 80, 440 

Confinement, preparations for, 9-17 

Constipation, 253-257; Castile soap and 
candy suppositories, 256; during 
pregnancy, 4 ; due to sterilized milk, 
421 ; eneraata and laxative medi- 
cines, 1.32; effect of an enema, 257; 
habitual, 127; hygienic treatment, 
129; in a bottle-baby, 255; in both 
mother and child, 253; in the mother, 
128; magnesia as a laxative, 254; 
massage, 130; of rickets, 124; sup- 
positories, 131 ; value of fat as a 
remedy, 128; value of regular habits, 
256 

Consumption, unjustified fear of, 402 

Contagious disorders, caused by im- 
pure milk, 81; chicken-pox, 145; 



diphtheria, 139, 229 ; German measles, 
145; measles, 144. 145, 146, 147; 
mumps, 145, 146, 148; scarlatina, 84, 
144, 145, 146, 147, 229; small-pox, 145; 
susceptibility to second attacks, 367; 
symptoms of, 144; whooping-cough, 
141, 145, 243, 245 

Convulsions, treatment of, 178 

Copperas, 364 

Corns, incipient, 355 

Corrosive subUmate, antidote for, 180 

Coryza, 235 

Coughs, "tight"' and "loose," 235; 
varieties of, 140; whooping-cough, 
243 

Cow, proper care of, 83 

Cow's milk, constituents of, 86; modi- 
fied, 88 ; percentage of fat in various 
breeds, 86 ; purity of, 82 ; separation 
of cream, 95; various mixtures, 95; 
varying proportions, 91 

Crackers, 105 

Cream, as a laxative. 111, 254; food 
formula, 264; frozen, unsuitability 
of, 435; separation of, 95; value of, 
88 

Creatin, 101 

Creatinin, 101 

Creosote, antidote for, 180 

Cross-eyes, 339, 340 

Croup, cough of spasmodic, 140; cry 
in, 35, 139 ; diphtheritic, 140 ; hoarse- 
ness in, 236; membranous, 280; true 
and false, 282 ; what to do in an at- 
tack of, 215 

Crown, of the teeth, 67 

Crying, as a cause of rupture, 395 ; as 
evidence of hunger, 35; caused by 
over-feeding, 35 ; due to thirst, 35 ; 
indicative of pain, 35; in illness, 
139 ; sedatives for, 394 

Curds, of breast milk and cow's milk, 
87 

Curvature, of the legs, 73; of the 
spine, 73 

Custards, 120 

Cuts, treatment of, 169 

Dairies, model, 83 

Dandruff, 351 

Dates, value of, 122 

Deaf -mutism, 231 

Deafness, partial, 347 

Defects and blemishes, 219-232; cleft 
palate and harelip, 2.30; deaf -mutism, 
231; fear of bow-legs, 227; freckles, 
219 ; habit of stumbling, 228 ; lisping, 
224 ; mark on baby's face, 220 ; reme- 
dies for bow-legs, 228; removal of 
birth-mark. 221; I'ound shoulders, 
226; stammering, 222; tongue-tie, 
229; umbilical growth, 225; want of 
symmetry in tlie formation of head, 
225 ; warts, 221 ; whopper-jaw, 230 

Demulcents, 236 



454 



INDEX 



Desserts, 119 

Dentine, or ivory, 66 

Dentistry for young children, 336, 337 

Dentition, 66-71 

Development and growth, 59-76; of 
special senses, 65 ; phases of, 307-312 

Diarrhoea, of rickets, 124; of typhoid 
fever, 288; rules for all cases, 133; 
summer complaint, 262 ; varieties of, 
132 

Diet, definition of nutritious, 242 ; dur- 
ing pregnancy, 3 ; general directions, 
77-123; laxative, 253; problems con- 
cerning, 408-448; the mother's, dur- 
ing nursing, 37, 390 

Digestive disorders, 258-265 ; apparent 
over-feeding, 263; causes and cure of 
scurvy, 127; causes of dirt-eating, 
265; changes caused by rickets, 
125; cure of rickets, 125; disturbed 
sleep due to, 322 ; domestic treatment 
of summer complaint, 262; due to 
improper feeding, 124-135; enemata 
and laxative medicines, 132 ; habitual 
constipation, 127; habitually coated 
tongue, 259; hygienic treatment of 
constipation, 129; indigestion, 264; 
infantile scurvy, 126; ''liver trou- 
bles," 261; massage, 130; paregoric 
for green movements, 265 ; probable 
case of dyspepsia, 258 ; remedies for 
weak digestion, 260; rules for all 
cases of diarrhoea, 133; signs of 
rickets, 260 ; stomach indigestion and 
colic, 134; suppositories, 131; symp- 
toms of rickets, 124; varieties of 
diarrhoea, 132 

Dinner-meals. 108 

Diphtheria, experiences with antitoxin 
in, 279, 280; how long do germs 
linger? 365; membranous croup, 280; 
precautions in, 277; sequels of, 229; 
symptoms of, 139 

Diphtheritic, croup, 140; throat trou- 
bles, 139, 281, 293 

Dipper, for removing cream, 97 

Dirt-eating, 265 

Diseases, 277-301; alcoholic stimulants 
in fever, 294; antitoxin as a pre- 
ventive and cure, 280; cod-liver oil 
in scrofula, 294; croup, 282; diph- 
theria and membranous croup, 280; 
falling of the bowel, 301; general 
experiences with antitoxin, 279 ; Ger- 
man measles, 290 ; heart-trouble, 293 ; 
hernia, 299. 300; hydrocephalus, 298; 
malarial disorders, 283, 284 ; measles, 
289; meningitis, 297; mumps, 292; 
precautions in a case of diphtheria, 
277 ; protruding navel, 300 ; rheuma- 
tism, 291; St. Vitus's dance, 293; 
scarlet fever, 288; sore throat, 292; 
tape-worm, 295; typhoid fever, 286, 
287 

Disinfectants, after confinement, 12; 



for domestic surgery, 188; sulphur 
fumigations, 363 ; various kinds, 364 

Disinfection, of paper money, 368 

Dover's powder, for colds, 237 

Dress and clothing, 44-58 ; advisability 
of going barefoot, 383; binder or 
band, 46; clothing for winter, 379; 
fashion in dress, 55; for pregnant 
women, 4; garments for older chil- 
dren, 57; garters and stocking-sup- 
porters, 381; Gertrude suit, 50; get- 
ting rid of pinning-blanket, 376; 
knitted band, 376 ; napkins, 46 ; night- 
cap, 378; night coverings, 377; night 
dress, 53 ; old-fashioned clothing, 50 ; 
principal requirements, 45; proper 
stockings and shoes for a depressed 
toe, 382 ; seasonable dress for a flve- 
months'-old, 376; shoes, 54: silk or 
flannel? 376; socks, 49; stiff soles 
for babies, 381; stocking-supporters 
and drawers, 56 ; stockings at night, 
378; summer dress, 378; summer 
night-clothing, 378; value of long 
stockings, 380 

Drooling, 332 

Drooping shoulders, 311 

Drowning accidents, what to do in, 
177 

Dullness, in school children, 75 

Dysentery, 132 

Dyspepsia, probable case of, 258 

Earache, cause and prevention, 349; 
cry of, 140 ; significance of a running 
ear, 350; treatment, 346 

Ears, evidences of trouble, 140; hard- 
ening of ear-wax, 349; of the new- 
born, cleansing of, 28; partial deaf- 
ness, 347; prominent, 347; removal 
of foreign bodies, 176 ; tampering 
with large, 348 

Eczema, 267, 353 

Effervescing waters, value of, in preg- 
nancy, 16 

Egg albumen, 79 

Eggs, for weak digestion, 439; value 
of, 111 ; when admissible, 105 

Electricity, for the removal of mother's 
marks, 221 

Emergencies, 169-181; accidents due 
to poison, 179; bruises and bumps, 
170; burns and scalds, 173; cautions 
as to fire, 174 ; convulsions, 178 ; do- 
mestic surgery, 169; drowning acci- 
dents, 177; frost-bite and chilblains, 
174; nose-bleed, 176; punctured 
wounds, 170; ragged wounds, 170; 
removal of foreign bodies, 175; 
sprains, 173 

Emetics, for household use, 187; in 
poisoning cases, 179 

Emulsions of cod-liver oil, how to give, 
165 

Enamel of the tooth, 67, 333 



INDEX 



455 



Enema, during pregnancy, 7 ; for colic, 
135, 194; for constipation, 132, 255, 
257 ; how to give an, 160, 404; in con- 
vulsions, 179 

Epilepsy, nocturnal, 33 

Epsom salts, as antidote for carbolic 
acid, 180; as purgative, 180; doses 
of, 189 

Eniptions, 266-276; black-heads, 272; 
characteristics of mild and of serious, 
266; ''driving in" eczema, 267; heat- 
rash, 268; herpes, 272; hives, 274; 
psoriasis, 270 ; 'red-gum, 269 ; ring- 
worm, 271; seborrhoea, 271 

Exercise, for gii'ls, 367 ; for older chil- 
dren, 41; rapid carriage-driving, 398 

Expectorants, 237 

Extractives, value of, 101 

"Eye teeth," 67 

Eyes, as affected by illness, 137 ; astig- 
matism, 345; chronic conjunctivitis, 
290 ; clipping the eyelashes, 343 ; eye- 
strain as a cause of headache, 343; 
granular eyelids, 344; needless anx- 
iety about brilliant, 341 ; of the new- 
born, care in cleansing the, 28; pink- 
eye, 344; pupils of different sizes, 
341; removal of foreign bodies, 175; 
squint, 339 ; sties, 342 ; test for cross- 
eyes, 340; "weeping" eye, 343; when 
babies begin to see, 308 

Fainting, what to do in, 218 

Farina, 119 

Fats, in breast milk, 78 ; in cow's milk, 
86 ; uses of, 436 ; value of, in consti- 
pation, 128 

Fauces, examination of, 138 

Feeding, 77-123,408-448; abuse of sugar, 
431 ; artificial, 80 ; balls from Graham 
flour, 425; bananas, apples and or- 
anges, 430 ; barley water, 423, 424 ; bot- 
tle versus spoon, 413; breaking the 
"bottle habit." 431; butter and eggs, 
439; buttermilk, 434; can the nurse's 
or mother's milk be poisonous I 411 ; 
cocoa, 438; combined nursing and 
bottle-feeding, 414; condensed milk, 
440 ; dangers from impure milk, 420 ; 
diet of a premature child, 438; die- 
tary in slow teething, 444; distaste 
for* meat, 447 ; does sterilized milk 
constipate? 421; during night, 92; 
effect of tea on children, 437 ; effect 
of the mother's diet upon the child's 
teething, 417; evils of early mixed 
feeding, 417; excessive vomiting, 
443 ; flow of milk the first days after 
delivery, 411 ; fondness for salt, 435 ; 
food versus sleep, 422; frequent 
changes of food, 443; fruit and milk, 
428; goat's milk and ass's milk, 412; 
Graham and white bread, 424 ; " hard- 
reared" children, 441; honey and 
molasses, 426; ice-cream, 434; imper- 



fect nutrition, 445; injurious quan- 
tity of lime-water, 421; is oatmeal 
heating ? 428 ; keeping sterilized milk 
in summer, 421; loss of appetite, 
445 ; need of water to quench thirst, 
432; new bread and cookies, 424; 
night feeding after weaning, 418; 
nursing another baby in addition to 
one's own, 416; oatmeal gruel, 424; 
oatmeal gruel as a laxative, 427 ; ob- 
jections to giving breast milk with a 
spoon, 413; on breast milk, 77-79; 
over-feeding, 443 ; popcorn, 427 ; prob- 
lems concerning diet, 408-448; pure 
versus diluted milk, 433; sage-tea, 
431 ; scum on boiled milk, 419 ; selec- 
tion of a wet-nurse, 408 ; signs of in- 
suflBcient breast milk, 415; straw- 
berries, 429; "sucking wind," 414; 
supply of breast ndlk as compared 
with the allowance of bottle-fed ba- 
bies, 416; teaching baby to eat, 432; 
testing the quality of breast milk, 
412 ; tests of rich milk, 419 ; uses of 
fat in foods, 436; variety in food, 
437; various cereals, 425; various 
milk mixtures, 95; warning against 
sour milk, 419; when sterilization 
is necessary, 420 ; why frozen cream 
is unsuitable, 435 

Feet, cold, 197 ; disinclination to stand, 
249; distorted, 356; incipient corns, 
355 ; ingrowing nails, 357 ; perspiring, 
197; turning in, 249 

Fever, indications of, 143 ; intermittent, 
284 ; malarial, 284, 367 ; remedies for, 
188; typhoid, 288: use of thermom- 
eter in, 143, 183 ; varieties of, 144 

Figs, value of, 122 

Filters, proper and improper, 362 

Finger-nails, care of, 400 

Fingers, supernumerary, 25 

Fir-pillow, 319 

Fire, accidents due to, 174 

Fish as food, 113 

Flannel garments, 56, 377 

Flatulence, as cause of colic, 135 

Flaxseed, poultices, 156; tea, 236 

Follicular tonsilitis, 139, 293 

Fomentations, 155 

Fontanelles, closing of, 64 

Food and feeding, 77-123. 408-448 ; ani- 
mal foods. 111 ; artificial feeding, 80- 
99 ; bottles, nipples and measures, 93 ; 
breast milk, constituents of, 77 ; bread 
and cereals, 118; broths and meat- 
juice, 100; cereal foods, 80; chewing 
teeth, 104; constituents of cow's milk 
86; cow's milk, 81; desserts, 119 
feeding after the second year, 108 
feeding conveniences, 97; feeding of 
older children, 103; fish as food. 113; 
five meals, 108; fruit, 121; fruits as 
laxatives, 107 ; general rules for diet, 
109; gruels, 99; gruels and porridges, 



456 



INDEX 



106; macaroni, 119; malted foods, 80; 
meat and eggs, 104; milk foods, 80; 
modified mUk, 88; objections to 
sweets, 122; potatoes, 107; purity of 
the milk supply, 82 ; second year, 101 ; 
separation of cream, 95; soups, 115; 
sterilization, 98 ; third year and there- 
after, 111 ; value of eggs. 111 ; value 
of variety, 437; various meats, 112; 
various mixtures, 95; various prob- 
lems concerning diet, 408-448 ; vary- 
ing proportions in feeding, 91 ; vege- 
tables, 115; water and other drinks, 
122 ; zwieback and crackers, 105. 

iPoot, natural shape of baby's, 54 

Foot-warmer, 57 

Foreign bodies, in eye, ear, nose, etc., 
175 

Foreskin, irritation of, 321 

Fountain syringe, uses of, 183 

Freckles, 219 

Front teeth, development of, 67 

Frost-bite, 174 

Fruits, as laxatives, 107 ; incompatibil- 
ity with milk, 428 ; various kinds, 121 

Fuller's earth, 270 

Fungous growth at the navel, 226 

Furniture of the nursery, 23 

Gargling, value of, in sore throat, 292 

Garments, problems concerning, 376- 
384; various, 44-58 

Garters, 381 

Gauze, for household surgery, 184, 301 

German measles, eruption of, 146; in- 
cubation period of, 145 ; isolation pe- 
riod, 147; peculiarities, 290; period 
of invasion, 145 

Gertrude suit, the, 50 

Girls, growth of, as compared with 
boys, 61, 63 

Glands, enlarged, 198 

Glauber's salt, as antidote for carbolic 
acid, 180 

Glycerin, enema, 135; for sprue, 201; 
suppositories, 131, 255 

Goat's milk, 412 

Graduated glass for medicines, 182 

Graham bread, 254, 425 ; flour, 425 

Granular eyelids, 344 

Grape juice, value of, in infantile 
scurvy, 127 

Grapes, 121 

Grippe, cough of, 141 ; poison of, 236 

Gritting of the teeth, 211 

*' Growing pains," 292 

Growth and development, 59-76 ; back- 
wardness, 76; gain in height, 62; 
gain in weight, 59; muscular devel- 
opment, 64 ; need of proper hygienic 
surroundings, 74; outgrowing de- 
fects, 73; overstudy and precocity, 
75 ; phases of, 307-312 ; phimosis, 74 ; 
satisfactory evidences of, 71 ; special 
senses, 65 



Gruels, admissibilty of, 99 ; how to pre- 
pare, 106 

Gum lancet, need of, 71 

Gums, affected by infantile scurvy, 
126; tenderness of, 138, 329 

Gymnastic exercises for stammering, 
223 

Habits, chewing of gum, 305; harm- 
ful, 302-306 ; holding the breath, 303 ; 
lip-sucking, 306; nail-biting, 304; 
objections to "baby's comforter," 
302 ; thumb-sucking, 302 

Hair, belief that long hair is weaken- 
ing, 353; falling out after confine- 
ment, 393; strengthening of thin, 
351; tampering with the color of, 
353 

Hammock, as a sleep-inducer, 316 

Hands, cold, 196 

''Hardening" theory, in practice, 372; 
objections to, 233, 371 

Harelip, 25, 230 

Head, changes in, due to rickets, 125; 
perspiration of, in rickets, 260 ; want 
of symmetry in its formation, 225 

Headache, as a symptom, 137; due to 
eye-strain, 343 

Hearing, first manifestations of, 65 

Heart-burn, during pregnancy, 6 

Heart trouble, signs of, 293 

Heat-rash, 268 

Heating of the nursery, 19 

Height, gain in, 62 

Hernia, causes, 299 ; characteristics of, 
299; due to crying, 395; treatment, 
300 

Herpes, 272 

Hiccough, cause and cure of, 208 

Hip disease, 250 

Hives, 274 

Hoarseness, various causes of, 235 

Hominy, 119 

Honey, 426 

Hydrocephalus, 137, 298 

Hygiene and sanitation, 359-375 ; baby 
powder, 368 ; danger of typhoid fever 
to babies, 367 ; desirability of keeping 
water on the stove. 361; disinfec- 
tants, 364; disinfecting paper money 
from a sick-room, 368; gas-stove in 
the nursery, 365; "hardening" the- 
ory, 371, 3^2; how long do diphthe- 
ria germs linger I 365 ; overstudy as 
a cause of chorea, 374 ; physical ex- 
ercise for girls, 367; plants in the 
bedroom, 361; proper and improper 
filters, 362; quinine as a preventive 
of fever and ague, 364 ; rational and 
injurious school work. 373; school- 
lunch, 373 ; sulphur for disinfection, 
363 ; susceptibility to second attacks 
of disease, 367; temperature of the 
nursery and the bedroom. 364 ; treat- 
ment of nervous children, 369; vac- 



INDEX 



45' 



cination, 359, 360 ; value of water in 

rheumatism, 369 
Hypophosphite, 333 
Hypnotics, warning against, 395 
Hysterical peculiarities, 265 

Ice-bag, use of, in sprains, 173 

Ice-cream, 120, 434 

Illness, 136-161, 277-301; breathing, 
140; cathartics, 159; characteristic 
eruptions, 146; cold ^om presses, 155; 
common diseases, 2 < 7-301 ; domestic 
treatment of, 149-161 ; ears, 140; evi- 
dences of, 136-148; fevers, 143; gen- 
eral beha\'ior during, 135; giving 
of an enema, 160; head, face and 
eyes, 137; hot applications, 155; in- 
vasion period, 14a ; period of isolation, 
147; poultices, 156; precautionary 
measures, 150; I'emedial baths, 151- 
155; signs about the mouth, 138; 
symptoms of contagious diseases, 
144; throat troubles, 138; urine 
and bowel discharges, 142; various 
coughs, 140; voice, 139; vomiting, 141 

Incised wounds, 169 

Incisors, development of, 67 

Incubation, periods of, in contagious 
diseases, 144 

Indian corn, preparations of, 119 

Inflammatory dianrhoea, 132, 142 

Influenza, cough of, 141; poison of, 236 

Ingrowing toe-naOs, 357 

Injuries, treatment of, 169 

Intermittent fever, 284 

Intestinal worms, 212, 213, 295 

Iodoform gauze after confinement, 13 

Ipecac, syrup of, 187, 237 

Iron preparations, how to give, 165 

Iron, sulphate of, 364 

Isinglass plaster, 184 

Ivory or dentine, 66 

Jaundice, 297 
Junket, 119 

Kissing, by force, 406; dangers from 

indiscriminate, 407 
Klebs-Loeffler baciUus, 281, 366 
Knock-knee, 247, 252 

Lacerated wounds, 170 

Lactalbumen, 78, 87 

Laryngitis, 235 

Larynx, seat of the cry of croup, 35 

Laxatives, during pregnancy, 7; for 
constipation, 132; for indigestion, 
261; for worms, 212; value of fruits, 
107. 254 

Left-handedness, 312 

Lemon-juice, as an antidote for alkali- 
poisoning, 180 

Lifting the baby, proper method of, 
399 

Light, first recognition of, 65 



Light and air, value of, in the nursery, 
18 

Limbs, disorders of, 247; possibly over- 
burdened, 248 ; weakness of. 250 

Lime-water, as an emetic, 180; for 
burns, 173 ; for colic, 187 ; for rickets, 
227; for sprue, 200; in heart-burn 
of pregnancy, 7; injurious quan- 
tity. 421; to be added in sterilizing 
food, 99 

Limp, significance of, 250 

Linseed-oil, for burns, 173 

Lip-sucking. 306 

Lips, ci'acked, 218 

Liquid diet, 77-99 

Lisping, treatment of, 224 

Listerine, uses of, 236 

Litmus-paper, use of, 261 

"Liver ti'oubles," 261 

Lymphatic troubles, caused by measles, 
290 

Macaroni, 119 

Magnesia, as a laxative, 254; as an 
emetic, 180 

Magnesia preparations, for the heart- 
burn of pregnancy, 7 

Malarial disorders, 283, 284 

Malt-sugar, as substitute for milk- 
sugar, 79 

Mark, on baby's face, 220, 221 

Massage, for constipation, 130, 256 

Measles, characteristics of, 289; compli- 
cations, 290; eruption of, 146, 267; 
incubation period of, 144; isolation 
period, 147; period of invasion, 145 

Measure, for milk and water, 94 

Measurements, of boys and girls, 308 

Measuring-glass, for medicines, 182; 
for milk mixtures, 97 

Meat, 112; beef and mutton, 112; dis- 
taste for, 447 ; poultry, 112 ; salted and 
smoked, 112; when admissible, 105 

Medicine chest, 182 

Medicines, administration of, 162-168; 
castor-oil, 165; for household use, 
182-189; in solid form, 166; iron 
preparations, 165; liquid, 163; rules 
for the sick-room, 168; swallowing 
made easy, 167 

Melons, value of, 121 

Membranous croup, 280 

Meningitis, causes of, 140, 297 

Menstruation, effect of, upon the 
mother's milk, 38 

Milk, constituents of, 86; during the 
second year, 101 ; goat's and ass's, 
412; hot, for an attack of croup, 215; 
impure, 420; in the nursing mother's 
diet, 37; laboratories, H9; model 
dairies, 83; modified, 88; of the 
breast, 77-80; pure versus diluted, 
43:?; purity of supply, 82; scum on 
])oiIe(l. 419; smuggled into the bill of 
fare, 430 ; sterilized, 420, 421 : sudden 



ii 



458 



INDEX 



^ 



curdling of, 261 ; tests of richness, 419 ; 
warning against sour, 419 

Milk-crust, 353 

"Milk" teeth, 66 

Milk sugar, 78 

Mint tea, for colic, 135 

Mixed feeding, 417 

Model milk-farms, 83 

Modified milk, 88 

Molars, development of, 67 ; '•* six-year- 
old," 68 

Molasses, 426 

Moles, 25 

Monthly nurse, the, qualifications of, 8 

"Morning sickness" of pregnancy, 6 

Morphia, in convulsions, 178 

Mosquitoes, as breeders of malaria, 285 

Mother, care of, 385-393; diet of a 
nursing, 390 ; drying up the mother's 
milk, 391 ; effect of the mother's diet 
upon the child's teething, 417; excess 
of abdominal fat, 392 ; falling out of 
the hair after confinement, 393 ; ner- 
vousness in the mother as a cause 
of baby's colic, 385; "nursing sore 
mouth," 391; sensitive breast, 387; 
sore nipples, 388 

Motherhood, preparation for, 3-17 

Mothers' marks, 220, 221 

Mother's mUk, 77-80 

Mouth, as affected by illness, 138 ; sore, 
202, 203 ; washing of the, 404 

Mouth-breathing, 198 

Muffins, inadmissibility of, 118 

Mumps, contagiousness of, 292 ; incuba- 
tion period of, 145 ; isolation period, 
148; period of invasion, 146 

Muscles, development of, 64 

Mustard, as an emetic, 186 

Mustard-pack, in convulsion, 178; 
-plaster, 157, 406 

Mutton, digestibility of, 112 

Mutton broth, value of, 101 

Nail-biting. 304 

Napkins, 46-49 

Narcotics, warning against, 395 

Nasal catarrh, 237, 238, 239 

Navel, growth on, 226 ; protruding, 300 

Navel-string, separation of, 28 

Nettle-rash, 274 

Near-sight, as cause of stumbling, 229 

Nervousness, definition of, 402 ; in con- 
nection with bed-wetting, 207 ; in the 
mother as a cause of baby's colic, 
385; tendency to, 74; treatment of, 
369 

New-born, first care of the, 25-29 

Night feeding, 92; garments, 53, 377, 
378 ; meal, dropping of, 314 ; terrors, 
32, 320 

Night lights in the nursery, 22, 318 

Nipple-shield, 37 

Nipples, cracked, remedies for, 7 ; sore, 
388 



Nitre, sweet spirits of, for fever, 188 

Nitrogenous elements of breast milk, 
78 

Nose, obstructions in, 198 ; of the new- 
born, cleansing of, 28 ; persistent itch- 
ing of, 214 ; removal of foreign bod- 
ies, 175 

Nosebleed, 176, 210 

Nostrils, as affected by illness, 138 

Nursery, appointments of the, 18-29; 
chair, teaching the use of, 399; fur- 
nishings, 23 ; light and air, 18 ; lights 
in the, 22; perplexing points in the 
nursery routine, 394-407; proper 
temperature of, 22; routine, 30-39; 
ventilation and heating, 19 

Nursing, accompanied by colic, 195; 
and bottle-feeding combined, 414; 
during pregnancy, 315 

Nursing-bottles, 94 

"Nursing sore mouth," 391 

Nutrition, imperfect, 310, 445 

Oatmeal, as a laxative, 254; constitu- 
ents of, 104; value of, 426, 428 

Oatmeal-gruel, 99, 424, 427 ; -water, 99, 
261 

Oiled silk, for poultices, 158; to cover 
dressings, 185 

Olive oil, various uses of, 186 

Onions, 117 

Opium, preparations of, 188 

Orange, as a laxative, 254; when per- 
missible, 107, 430 

Orange juice, value of, in infantile 
scurvy, 127 

Outgrowing defects, 73 

Overalls, 57 

Overfeeding, apparent, 263, 443 ; conse- 
quences of, 159 

Overstudy, 75 

Oxalic acid, antidote for, 180 

Oysters, permissibility of, 114 

Palate, cleft, 230 

Paregoric, for pain, 188; for colds, 

237; for summer complaint, 263; in 

colic, 194 
Paris green, antidote for, 180 
Pasteurization, as distinguished from 

sterilization, 98 ; of the milk supply, 

86 
Pastries, objection to, 120 
Patches, n tongue, 199 
Peaches, value of, 107, 254 
Pears, 120, 254 
Peas, 116 
"Peeling," in German measles, 291; 

in scarlet fever, 289 
Peppermint, spirit of, 187, 194 
Permanent teeth, development of, 68 
Perspiration, of rickets, 124, 260 
Peruvian bark, 275, 285 
Phimosis, as cause of bed-wetting, 207; 



INDEX 



459 



causing the stumbling habit, 229; 
description of, 74 

Pharyngitis, 293 

Pharynx, aflfections of, 139; obstruc- 
tion of, 199 

Phosphate, for strengthening the 
teeth, 334; of lime, in breast milk, 
78; of soda as a laxative, 261 

Phosphorous poisoning, antidote for, 
180 

Pigeon-breast, due to rickets, 125 

Pillow, of fir needles, 319; of hops, 
319; value of, 318 

Pin-worms, 213, 323 

Pinning-blanket, 3<6 

Pink-eye, 344 

Plant-poisoning. 181 

Plants, in the bedroom, 361 

Plaster, mustard-, 157 

Playing with young children to be 
discouxitenanced, 75 

Pleurisy, false diagnosis of, 236 

Pneumonia, application of poultices in, 
156; cough of, 141; ciy in, 35; er- 
rors in diagnosis, 236; oiled-siLk 
jacket in, 159 

Poisoning, accidental, 179; due to 
plants, 181 

Pop-corn, 427 

Porridges, how to prepare, 106; value 
of, 104 

Posture as a symptom, 136 

Potash, antidote for, 180 

Potatoes, often given too early, 107; 
sweet, 115 ; when permissible, 107 

Pott's disease, 251 

Poultices, how to apply, 157; various 
kinds of, 156 

Poultry, admissibility of, in the diet, 
112 

Precocity, 75 

Pregnancy, alkalis against discomforts 
of, 7; baby basket, 13; bath during, 
5 ; care of the breasts and nipples, 7 ; 
constipation in, 4 ; diet during, 3 ; dis- 
comforts of, 5; disinfectants after 
confinement, 12; dress and clothing 
for, 4 ; effervescing waters admissible, 
6; examination of urine advisable, 
16; general care during, 3-18; heart- 
bum, 6; "morning sickness," 6; lax- 
atives, 7; nursing during, 315; out- 
fit of the lying-in chamber, 10; 
swelling of the veins, 4 ; time of con- 
finement, 9 

Premature child, feeding of, 438 

Prickly heat, 266 

Proportions in height, 62 

Proteids, in cow's milk, 86; in the 
nursing mother's diet, 37; of breast 
milk, 78; proportion of, 109 

Prunes, when permissible, 107 

Psoriasis, 270 

Pulmonary troubles, symptoms of, 140 

Pulse, rate of, in illness, 140 



Pumpkin-seed, against tape worm, 296 
Punctured wounds, 169 
Purgatives, 7, 107, 132, 212, 261 

Quinine, 285, 364 
Quinsy, 293 

Rachitis, 124, 125, 225, 228, 240, 260 

Ragged wounds, 170 

Red-gum, 269 

Remedies, for household use, 182-189; 
for malarial fever, 284 

Rennet whey, 134 

Respiration, in health and illness, 140 

Restlessness, as a svmptom, 136 

Rheumatism, 198, 291, 369 

Rhinitis, 236 

Rhubarb, 275 

Rice, in the diet, 119 ; puddings, 120 

Rickets, bow-legs due to, 228; causes 
and cure of, 125; causing delay in 
teething, 331; changes due to, 125, 
225 ; sweating of the head suggestive 
of, 240, 260 ; symptoms of, 124 

Ringworm, 271 

Rocking habit, 31, 396 

Rotheln, 290 

Round shoulders, causes of, 226; ten- 
dency to, 73 

Round-worm, 323 

Rubber diaper, objections to, 48 

Rubber nipples, as "comforters," 31, 
316 : care of, 94. 203 ; proper kind, 94 

Rubber plaster, 184 

Rupture, causes of, 299; characteristics 
of, 299; due to crying, 395; treat- 
ment, 300 

Sage-tea, 431 

Sago, 119 

Saint Vitus's dance, 293, 325, 374 

Saliva, development of, 309; increased 

flow in teething, 332 
Salt, as an emetic, 186; for an enema, 

186; inordinate fondness for, 435 
Salts, in cow's milk, 86 ; of breast milk, 

78 
Salicylic acid,';for removal of warts, 222 
Sanitation and hygiene, 359-375 
Santonine, as a remedy, 212 ; as affect- 
ing the urine, 142 
Scalds, treatment of, 173 
Scalp, cleansing of, in first bath, 28; 

milk-crust, 353; strengthening thin 

hair, 351 ; use of soap, 352 ; washing 

of, 352 
Scarlatina, caused by contaminated 

milk, 84; characteristics of. 267, 289; 

complications, 290; eruption of, 146; 

incubation period, 144; isolation 

period, 147; meaning of term, 282; 

period of invasion, 14o 
School-lunch, .373; -work, rational and 

injurious, 373, 374 
Scrofula, treatment for, 295 



460 



INDEX 



Scurvy, causes and cure, 127; infan- 
tile, symptoms of, 126 

Sea bathing, effects of, 39 

Seborrhoea, 271, 351 

Second teeth, 68 

Sedatives, 394 

Senses, special, development of, 65 

Shingles, 272 

Shoes, harm done by improper, 357; 
proper, 54, 197, 382 ; stiff soles, 381 

Shoulders, drooping, 311; round, 226 

Silk, value of, as underwear material, 
377 

Sitting, attempts at, 64, 396 

Skimmed cream, 102 

Skin, chafed, 218; diseases of, 266-276; 
in fever, 143 

Sleep, disorders of, 32; duration of, 
30-32; importance of regular hours, 
32; night terrors, 33; nocturnal epi- 
lepsy, 33; versus food, 422; walking 
in, 34 

Sleeping, best place for, 397 ; causes of 
night terror, 320; experimenting 
with anodynes, 317; fir-pillow, 319; 
hammock as a sleep inducer, 316; 
lying on the stomach, 320; night- 
light in the nursery, 318 ; objections 
to having children sleep with adults, 
319; position for sleep, 320; rubber 
nipple and sugar-rags as "com- 
forters," 316; special points con- 
nected with, 316-323; value of the 
pillow, 318 ; worms as possible causes 
of talking in sleep, 322 

Small-pox, incubation period of, 145 

Smell, first evidences of, 66 

Soap, desirableness of, in bathing, 325 ; 
-suds, as an emetic, 180; supposi- 
tories of, 255, 256; use of, on the 
head, 352 

Socks, 40 

Soda, bicarbonate of, for burns, 173 ; as 
a laxative, 255 

Soda-mint, 187, 196 

Sodium bicarbonate, for heart-burn of 
pregnancy, 7 

" Sore mouth," 202, 203 

Sore throat, 139, 292 

Soups, 115 

Spasmodic croup, cough of, 140 ; mean- 
ing of, 282 

Speech, development of, 66, 310 

Spinach, 117, 254 

Spine, curvature of, 73; tuberculous 
affection of, 251 ; weakness of, 251 

Splinter, removal of, 171 

Sponges, suitable for baby's bath, 16 

Sprains, treatment of, 173 

Sprue, 200, 202 

Squills, 237 

Squint, 339 

Stammering, treatment of, 222 

Starch, conversion of, into sugar, 79; 
excess of, as cause of rickets, 126 



Steak, when admissible, 105 
Sterilization, of food, 98; practised in 

model dairies, 84 
Sties, 342 
Stimulants, for the nursery pharmacy, 

188; for shock, 174; for revival of 

the drowning, 178; in fever, 294; in 

poisoning accidents, 181; objections 

to, 122 
Stocking-supporters, 381 
Stockings, 40, 196, 378, 380, 382 
Stomach indigestion, 134, 264 
"Stomach" teeth, 67 
Stools, in illness, 142, 265 
Stoop, tendency to, 227 
Stoves, for the nursery, 20, 365 
Strawberry, value of, 121, 429 
String-beans, 116 
Stumbling habit, 228 
Stupes, application of, 156 
Suckling, 34-38; care of the nipple, 36; 

evidences of suitable breast milk, 34 ; 

signs of unsuccessful, 35 
Sugar, in cow's mUk, 86; objection to 

excessive use of, 107, 431 
Sugar-teats, objections to, 31, 317 
Sulphate of copper, as antidote for 

phosphorus poisoning, 180 ; doses of, 

189 
Sulphites, 275 
Sulphur fumigations, 363 
Summer complaint, 262; diarrhoea, 132; 

dress, 378 
Supper-meal, 108 
Suppositories, during pregnancy, 7 ; for 

constipation, 131, 255, 256 
Surgery, domestic, 169-177 
Surgical, household implements for 

emergencies, 183 
Sweets, objections to, 122 
Swollen veins during pregnancy, 4 
Syringes, various kinds of, 160 

Tannic acid, as antidote for plant 

poisoning, 181 ; doses of, 189 
Tannin and glycerin, as a remedy for 

cracked nipples, 7 
Tape- worm, 295 
Tapioca, 119 

Taste, first manifestations of, 65 
Tea, effect of, on children. 437 
Tear-glands, development of, 309 
Teeth, care of. 69 ; development of, 66- 
70; discoloration, 335; early decay, 
334; effectof early feeding, 333; fill- 
ing of the first, 33/ ; gritting of, 211, 
323; peculiarities, 336; permanent 
set, 68; removing redundant, 336; 
rudimentary condition before birth, 
66; strengthening of , 333; temporary 
set, 67 ; unusual absence of upper in- 
cisors, 337; use of the tooth-brush, 
334; various parts of the, 66 
Teething, as a cause of colic, 194; as 
affacted by the mother's diet, 417; 



INDEX 



461 



diet in slow, 444; disturbances in 
connection with, 70; drooling, 332; 
late, 331; normal and painful, 328; 
process of, 70 

Temperature, in fever, 143; of baby's 
first bath, 27 ; proper, of the nursery, 
22, 364 

Temporary teeth, 67 

Throat, care of sensitive, 239 ; removal 
of foreign bodies from, 176 

Throat troubles, 138 

"Thrush,"' cause of, 202 

Thumb-sucking, effects of, 302 ; to pro- 
duce sleep, 31 

Toast. 105 

Toe-naUs, ingrowing, 357 

Toes, depressed, 382 ; turning in of, 248 

Tongue, coated, 138, 201, 259 ; patches 
on, 199 ; tie, 229 

Tonics. 275 

Tonsilitis, as related to rheumatism, 
292: symptoms of, 138; varieties of, 
293 

Tonsils, as affected in illness, 139 ; en- 
larged, 138, 198; removal of, 205; 
swollen, 203 

Tooth-brush, use of, 334 

Top-milk, value of, 88 

Touch, first manifestations of, 65 

Tricuspids, appearance of, 09 

Truss, use of, in hernia, 300 

Tubercular bacillus, affecting spine, 251 

Turpentine, oil of, against tape-worm, 
296; spirits of, in hot applications, 
156 

Typhoid fever, 286, 287, 367 

Umbilical cord, 28; growth, 225 
Urinary obstruction in the new-born, 25 
Urine, advisability of examination 

during pregnancy, 16; changes in, 

due to illness, 142 
Urticaria, 274 
Uvula, enlarged, 199 

Vaccination, 359, 360 

Vapor bath, 154 

Varioloid, incubation period of, 145 

Vaseline, uses of, 26, 130. 160, 185 

Veal, unsuitability of, 112 

Vegetables, in the diet of children, 
115-118 

Veil, objections to, 399 

Veins, swollen, during pregnancy, 4 

Ventilation, in the nursery, 19; protec- 
tion from drafts, 'A\)7 

Verdigris, antidote for, 180 

Vermifuges, 212 

Veniix caseosa, removal of, 26 



Vinegar, as antidote for alkali-poison- 
ing, 180 

Vision, beginning of, 309 

Voice, changes in, due to illness, 139; 
roughness of, 206 

Vomiting, as a symptom, 134; exces- 
sive, 443 ; in scarlet fever, 289 ; vari- 
eties of, 141 

Walking, beginning of, 64 ; difiaculties 
of, 247-252 ; disinclination to put the 
foot do\vn, 249; knock-knee, 252; 
possible dangers from early, 247; 
possibly overburdened limbs, 248; 
Pott's disease. 251; signification of 
a limp, 250; turning-in of the toes, 
248; weak ankles, 252; weak limbs, 
250 

Wardrobe, 44-58, 376-384 

Warts, removal of, 221 

Water, as a drink, 122; chief constitu- 
ent of breast milk, 78 ; for constipa- 
tion, 129 ; in cow's milk, 86 ; need of. 
to quench thirst, 432; value of, in 
rheumatism, 369 

"Water on the brain," 137, 298 

Wax, impaction of, in the ear, 346, 349 

Weak ankle. 247, 252 

Weaning, dropping the night meal, 
314; feeding after, 418; mode of, 
313-315; nursing during pregnancy, 
315 ; system in, 313 

Weight, at various ages, 308; gain in, 
60; normal, 307 

Wet-nurse, selection of, 408 

WTieaten preparations, value of, 119 

Whey, 134 

Whole-wheat flour, 104 

Whooping-cough, contagion of, 245; 
first symptoms, 243 ; incubation pe- 
riod, 145; period of isolation, 1^; 
severity of, in relation to age, 245 ; 
signs of, 141 ; supposed ignorance of 
physicians concerning, 244 

' ' Whopper-j a w, " 230 

" Wind-sucking," 414 

Winter clothing, 379 

Wisdom teeth, appearance of, 69 

Witch-hazel extract, use of, 172 

Woolen garments, value of, 45, 380 

Worms, as possible causes of talking 
in sleep, ."{22; cause of pin-worms, 
213; supposed signs of, 211, 212; 
tape- worm, 295 

Wounds, treatment of, 169 

Zinc ointment, 321 ; plaster, 184 
Zoster, 272 
Zwieback, 105 



1 



